Stable High Trajectory Research Articles

Trajectories of Externalizing Behavior Problems in Young Children and its Associations with Elementary School Adjustment and Executive Function Difficulties: Using Growth Mixture Modeling

Objectives This study examined types of trajectories for externalizing behavior problems from 4-6 year olds and differences in school adjustment and executive function difficulties of first-grade children for elementary school by types of trajectories for externalizing behavior problems. Methods The 2012-2015 data of Panel Study on Korean Children (PSKC) were used. The sample for this analysis was 1518 children and their mothers and teachers participated from the first (2012) to the fifth (2015) years. Data was analyzed using growth mixture modeling. Results First, externalizing behavior problems from 4-6 year olds showed linearly decreasing change over time. Second, four distinct latent classes of externalizing behavior problems for young children were found (low-decreasing trajectory, high-stable trajectory, moderate-increasing trajectory, and high-decreasing trajectory). Finally, there were differences the level of school adjustment and executive function difficulties by four distinct latent classes of externalizing behavior problems. Young children were on high-stable trajectory showed the lowest level of school adjustment and the highest level of executive function difficulties, while young children were on low-decreasing trajectory showed the highest level of school adjustment and the lowest level of executive function difficulties. These result showed that four distinct trajectories for externalizing behavior problems from 4-6 year olds was closely related to school adjustment and executive function difficulties of the first-grade children for elementary school. Conclusions Finding suggest the importance of the early intervention on young children’s behavior problems grounded by four distinct latent classes of externalizing behavior problems for young children. Keywords: externalizing behavior problems, school adjustment, executive function difficulties, trajectory, growth mixture model

Heterogeneity in Short-Term Suicidal Ideation Trajectories: Predictors of and Projections to Suicidal Behavior.

Little is known about suicidal ideation stability, including whether stability is heterogeneous or homogeneous between individuals. Studies of this kind are necessary to understand the progression from suicidal ideation to action. This study examined suicidal ideation trajectories, using growth mixture modeling, in a sample of 359 past/current military service members (M age=32.1years, SD=7.7; 88.3% male). Self-reported suicidal ideation information was collected at baseline and follow-up sessions at months 1, 3, 6, and 12. Following extraction of the best-fitting solution, predictors of trajectory status were examined and trajectory status was used to predict suicidal behavior between baseline and month 12 assessments. Results revealed four trajectories, Low-Stable (n=125), Moderate-Stable (n=101), High-Stable (n=76), and High-Rapidly Declining (n=57). In general, the High-Stable trajectory had the highest levels of perceived burdensomeness, thwarted belongingness, PTSD symptoms, and drug use. The High- and Moderate-Stable trajectories had the highest rates of suicidal behavior between baseline and month 12. Suicidal ideation, even in individuals with elevated ideation, is not a homogeneous construct over time. Stability of suicidal ideation might be an important risk factor, even if ideation is only moderately elevated.

Behavioral problem trajectories and self-esteem changes in relation with adolescent depressive symptoms: a longitudinal study.

Prospectively childhood behavioral problems and low self-esteem are associated with depression. However, these mental health changes over time have never been examined. This study assessed the association of childhood behavioral trajectories and self-esteem changes over time with adolescent depressive symptoms. Parent-reported Rutter behavioral assessments and self-reported Culture-Free Self-Esteem Inventories (SEI) were obtained via record linkage from the Student Health Service, Department of Health (Hong Kong), and the Patient Health Questionnaire-9 (PHQ-9) depressive symptom scores were obtained via active follow-up of the Hong Kong's Children of 1997" Chinese birth cohort. Partitional clustering was used to generate homogenous trajectories between ~ 7 and ~ 11years for Rutter scores. Changes in low self-esteem between ~ 10 and ~ 12years were obtained from the SEI. Multiple linear regression was used to estimate their associations with depressive symptom scores at ~ 13years. Four trajectories/groups (stable low, declining, rising, and stable high) of Rutter score and self-esteem groups were created. The stable lowbehavioral trajectory was associated with thefewest depressive symptoms while the stable high trajectory had 1.23 more depressive symptoms [95% confidence interval (CI) 0.84 to 1.61] than the stable low trajectory. Consistently low self-esteem (stable low) was associated with 2.96 more depressive symptoms (95% CI 2.35-3.57) compared to consistently high self-esteem (stable high). Sustained or worsening childhood behavioral problems and low self-esteem were precursors of adolescent depressive symptoms, and as such could be an early indicator of the need for intervention.

Association of Trajectories of Higher-Level Functional Capacity with Mortality and Medical and Long-Term Care Costs Among Community-Dwelling Older Japanese.

Higher-level functional capacity is crucial component for independent living in later life. We used repeated-measures analysis to identify aging trajectories in higher-level functional capacity. We then determined whether these trajectories were associated with all-cause mortality and examined differences in medical and long-term care costs between trajectories among community-dwelling older Japanese. 2,675 adults aged 65-90 years participated in annual geriatric health assessments and biennial health monitoring surveys during the period from October 2001 through August 2011. The average number of follow-up assessments was 4.0, and the total number of observations was 10,609. Higher-level functional capacity, which correspond to the fourth and fifth sublevels of Lawton's hierarchical model, was assessed with the Tokyo Metropolitan Institute of Gerontology-Index of Competence (TMIG-IC). We identified four distinct trajectory patterns (high-stable, late-onset decreasing, early-onset decreasing, and low-decreasing) on the TMIG-IC through age 65-90 years. As compared with the high-stable trajectory group, participants in the late-onset decreasing, early-onset decreasing, and low-decreasing TMIG-IC trajectory groups had adjusted hazard ratios for mortality of 1.22 (95% confidence interval: 1.01-1.47), 1.90 (1.53-2.36), and 2.87 (2.14-3.84), respectively. Participants with high-stable and late-onset decreasing higher-level functional capacity trajectories had lower mean monthly medical costs and long-term care costs. In contrast, mean total costs were higher for those with low-decreasing trajectories, after excluding the large increase in such costs at the end of life. People with a low-decreasing aging trajectory in higher-level functional capacity had higher risks of death and had high monthly total costs.

Trajectories of change in symptom distress in a clinical group of late adolescents: The role of maladaptive personality traits and relations with parents.

In this study, it was analysed whether trajectories of change in symptom distress could be identified in a clinical group of late adolescents with personality pathology. Furthermore, it was examined whether maladaptive personality traits and relations with parents were predictive of following one of these trajectories. Three latent classes emerged from growth mixture modelling with a symptom inventory (n = 911): a Stable High, a Strong Decreasing and a Moderate Decreasing trajectory. Subsequently, by using multinomial logistic regression analyses in a subsample of late‐adolescents (n = 127), it was revealed that high levels of Negative Affectivity and Detachment were predictive of following the Strong Decreasing, and high levels of Detachment were predictive of following the Stable High trajectory. Support from or Negative Interactions with parents were not predictive of any of the trajectories. The current results contribute to the notion of individual trajectories of change in symptom distress and provide suggestions for screening patients on personality traits to gain insight in the course of this change. © 2018 The Authors Personality and Mental Health Published by John Wiley & Sons Ltd

Physical Performance Trajectories and Mortality Among Older Mexican Americans.

We sought to identify distinct trajectory classes of physical performance in Mexican Americans aged 75 years and older and to examine whether these trajectories predict mortality. We used four waves of Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) data for adults 75 years and older from 2004-2005 to 2013. Latent growth curve analysis was used to identify distinct trajectory classes. Multinomial logistic regression analysis was used to examine the association between baseline characteristics and the newly constructed trajectories. Cox proportional hazards regression models examined the hazard of mortality as a function of Short Physical Performance Battery (SPPB) trajectories. The study follow-up period was approximately 9.5 years. One thousand four hundred and eleven adults were successfully classified into three (low-declining, high-declining, and high-stable) physical performance trajectory classes. Depressive symptoms (relative risk ratio = 1.94, 95% confidence interval [CI] = 1.17-3.22), diabetes (relative risk ratio = 2.44, 95% CI = 1.63-3.65), number of other comorbid health conditions (relative risk ratio = 1.40, 95% CI = 1.16-1.68), and obesity (relative risk ratio = 2.83, 95% CI = 1.67-4.80), increased the relative risk of classification into the low, relative to high-stable trajectory class. Male gender and foreign-born status significantly reduced risk of classification in the low-declining and high-declining trajectory classes. We observed a statistically significant association between low-declining (hazard ratio = 3.01, 95% CI = 2.34-3. 87) and high-declining (hazard ratio = 1.64, 95% CI = 1.32-2.03) trajectories and increased risk of mortality. Differences in mortality across physical performance trajectory classes suggest that these physical performance classes represent differences in underlying disease progression, and thus differences in mortality risk among older Mexican Americans, which warrants additional research to better understand differential physical performance trajectories and their effects on morbidity and mortality in heterogeneous aging populations.

Trajectories of Racial Discrimination that Predict Problematic Alcohol Use among African American Emerging Adults.

The association between racial discrimination (discrimination) and problematic alcohol use in African American (AA) emerging adults is well documented. Few researchers, however, have studied the longitudinal relationship between discrimination and problematic alcohol use among AA male and female emerging adults. In a sample of 681 AAs aged 19-25 (51% male), we explored multiple, distinct trajectories of discrimination and socio-demographic predictors of the trajectory classifications. We also examined the relation between discrimination trajectories and problematic alcohol use and the extent to which sex modified these associations. Collectively, the findings revealed that three trajectories - high-stable, low-rising, and low-declining - characterized discrimination experiences for AA emerging adults. Males in the high-stable trajectory class reported more problematic alcohol use than males in other trajectory classes and all females. These findings lay the foundation for future research that examines gender-specific mechanisms in the discrimination-health link.

Occupational prestige trajectory and the risk of lung and head and neck cancer among men and women in France.

This study aimed at investigating the associations between occupational prestige trajectories and lung and head and neck (HN) cancer risk and to assess to what extent smoking, alcohol drinking, and occupational exposures contribute to these associations. Using data from the ICARE case-control study (controls (2676 men/715 women), lung cancers (2019 men/558 women), HN cancers (1793 men/305 women), we defined occupational prestige trajectories using group-based modeling of longitudinal data. We conducted logistic regression models. Among men, a gradient was observed from the downward "low to very low" trajectory to the stable very high trajectory. The associations were reduced when adjusting for tobacco and alcohol consumption and occupational exposures. Among women, when compared to the stable high trajectory, there was an increased cancer risk in all trajectories. The associations remained globally unchanged or even increased after adjustment for tobacco and alcohol consumption and did not change when adjusting for occupational exposures. The ORs were smaller for lung than for HN cancers in men. Occupational prestige trajectory is strongly associated with lung and HN cancer risk in men and women.

Body mass index trajectories during infancy and pediatric obesity at 6 years

PurposeThe purpose of the article was to examine the relationship between body mass index (BMI) trajectories during infancy and risk of obesity at the age of 6 years. MethodsWe used data on 1169 children with at least two BMI measures during their first year of life from the Infant Feeding Practices Survey II and its Year 6 Follow-Up. Latent class growth analysis was used to identify distinct trajectories of BMI, and multiple logistic regression analyses were used to assess the association of the identified trajectories with obesity at the age of 6 years. ResultsThree trajectories of BMI were identified during the first year of life: low stable (80.2%), high stable (16.9%), and rising (2.8%). Obesity at the age of 6 years was highest among children with a high-stable trajectory (17.2%), followed by the low-stable (9.6%) and rising (9.1%) groups. Compared with those in the low-stable trajectory, the adjusted odds ratio for obesity at the age of 6 years was 1.79 (95% confidence interval 1.13–2.84) in children with the high-stable growth trajectory and 0.84 (0.26–2.72) in children with the rising growth trajectory. ConclusionsHigh-stable BMI trajectory in infancy resulted in a higher risk for obesity at the age of 6 years, but had low accuracy for identifying obese children at the age of 6 years.

Trajectories of musculoskeletal pain from adolescence to middle age: the role of early depressive symptoms, a 27-year follow-up of the Northern Swedish Cohort.

Depression and musculoskeletal pain are associated, but long-term follow-up studies are rare. We aimed to examine the relationship of early depressive symptoms with developmental patterns of musculoskeletal pain from adolescence to middle age. Adolescents ending compulsory school (age 16) in Luleå, Northern Sweden, in 1981 (n = 1083) were studied and followed up in 1986, 1995, and 2008 (age 43) for musculoskeletal pain. Attrition was very low. Indicators for any and severe pain were based on pain in the neck-shoulders, low back, and the extremities. Latent class growth analyses were performed on 563 men and 503 women. Associations of a depressive symptoms score (DSS, range 0.0-2.0) at age 16 with pain trajectory membership were assessed by logistic and multinomial regression, adjusting for parental socioeconomic status, social adversities, smoking, exercise, body mass index, and alcohol consumption at age 16. For any pain, 3 trajectories emerged: high-stable (women 71%, men 61%), moderate (11%, 17%), and low-increasing (18%, 22%). With the low-increasing trajectory as reference, for each 0.1-point increase in the DSS, the odds ratio of belonging to the high-stable trajectory was 1.25 (95% confidence interval 1.11-1.41) in women and 1.23 (1.10-1.37) in men. For severe pain, 2 trajectories were found: moderate-increasing (women 19%, men 9%) and low-stable. For each 0.1-point increase in the DSS, the odds ratio of membership in the moderate-increasing trajectory was 1.14 (1.04-1.25) in women and 1.17 (1.04-1.31) in men in the fully adjusted model. Thus, depressive symptoms at baseline are strongly associated with pain trajectory membership.

Gender differences in cumulative life-course socioeconomic position and social mobility in relation to new onset diabetes in adults—the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

PurposeWe investigated gender-specific associations of cumulative socioeconomic position across life course and social mobility with new onset diabetes mellitus (NODM) in over 12,000 civil servants in Brazil. MethodsWe used data from ELSA-Brasil baseline (2008–2010). The accumulation of risk was assessed using an education-based score and an occupation-based score. Educational and occupational social mobility were also evaluated. ResultsIn minimally adjusted models, NODM increased with increasing exposure to life-course social disadvantages, especially in men. This gender difference was pronounced when cumulative processes were evaluated by education-based scores (high vs. low cumulative social disadvantage, odds ratio [OR] = 4.7; 95% confidence interval [CI]: 2.6–8.5 in men and OR = 2.0; 95% CI: 1.1–3.6 in women). After including proximal diabetes risk factors possibly acting as mediators, these associations remained high only in men (high vs. low cumulative social disadvantage, OR = 4.4; 95% CI: 2.4–8.1). Social mobility was associated with NODM in men. Compared to the high-stable trajectory, downward had greater associations than upward mobility. In women, when considering metabolic syndrome–related variables, changes in social hierarchy did not seem to have an influence on their risk of diabetes. ConclusionsAccumulation of risk and social mobility were associated with NODM with gender-specific patterns, suggesting differences in mechanisms connecting life-course socioeconomic position and diabetes in men and women.

Target Tracking Using SePDAF under Ambiguous Angles for Distributed Array Radar.

Distributed array radar can improve radar detection capability and measurement accuracy. However, it will suffer cyclic ambiguity in its angle estimates according to the spatial Nyquist sampling theorem since the large sparse array is undersampling. Consequently, the state estimation accuracy and track validity probability degrades when the ambiguous angles are directly used for target tracking. This paper proposes a second probability data association filter (SePDAF)-based tracking method for distributed array radar. Firstly, the target motion model and radar measurement model is built. Secondly, the fusion result of each radar’s estimation is employed to the extended Kalman filter (EKF) to finish the first filtering. Thirdly, taking this result as prior knowledge, and associating with the array-processed ambiguous angles, the SePDAF is applied to accomplish the second filtering, and then achieving a high accuracy and stable trajectory with relatively low computational complexity. Moreover, the azimuth filtering accuracy will be promoted dramatically and the position filtering accuracy will also improve. Finally, simulations illustrate the effectiveness of the proposed method.

Trajectories of Physical Activity Over Two Years in Persons With Rheumatoid Arthritis.

To identify and describe different trajectories of physical activity over 2 years and to identify baseline predictors for each trajectory within a large cohort of people with rheumatoid arthritis (RA). The sample included 2,752 people ages 18-75 years and independent in daily living. Data on sociodemographic, disease-related, and psychosocial variables and physical activity (total weekly hours of vigorously/moderately intense activity and walking) were collected from registers and by questionnaires at baseline, and at 14 and 26 months. K-means cluster analysis was used to identify different physical activity trajectories. Multinomial logistic regression was used to identify predictors of trajectory membership. Three trajectories were identified: 1 stable high (n = 272; with an average of 25 hours of physical activity/week), 1 decreasing (n = 564; changing from 22 to 8 hours), and 1 stable low (n = 1,916; with an average of 3 hours). Predictors of the stable high trajectory versus the other 2 were male sex and already established physical activity at baseline. Predictors of the stable high trajectory versus decreasing trajectory were lower age and less social support for exercise, while predictors of stable high versus the stable low trajectory were less activity limitation and higher exercise self-efficacy. The results indicate that distinct trajectories of physical activity over 2 years in people with RA exist, and that stable, high physical activity is mainly predicted by male sex and already established physical activity at baseline. Additional predictors, amenable to change, include activity limitation, social support, and self-efficacy for exercise, suggesting a wide perspective on maintained physical activity in RA.

Joint developmental trajectories of internalizing and externalizing disorders between childhood and adolescence.

This study sought to identify trajectories of DSM-IV based internalizing (INT) and externalizing (EXT) problem scores across childhood and adolescence and to provide insight into the comorbidity by modeling the co-occurrence of INT and EXT trajectories. INT and EXT were measured repeatedly between age 7 and age 15 years in over 7,000 children and analyzed using growth mixture models. Five trajectories were identified for both INT and EXT, including very low, low, decreasing, and increasing trajectories. In addition, an adolescent onset trajectory was identified for INT and a stable high trajectory was identified for EXT. Multinomial regression showed that similar EXT and INT trajectories were associated. However, the adolescent onset INT trajectory was independent of high EXT trajectories, and persisting EXT was mainly associated with decreasing INT. Sex and early life environmental risk factors predicted EXT and, to a lesser extent, INT trajectories. The association between trajectories indicates the need to consider comorbidity when a child presents with INT or EXT disorders, particularly when symptoms start early. This is less necessary when INT symptoms start at adolescence. Future studies should investigate the etiology of co-occurring INT and EXT and the specific treatment needs of these severely affected children.

Trajectories of Suicidal Ideation in People Seeking Web-Based Help for Suicidality: Secondary Analysis of a Dutch Randomized Controlled Trial.

BackgroundSuicidal ideation (SI) is a common mental health problem. Variability in intensity of SI over time has been linked to suicidal behavior, yet little is known about the temporal course of SI.ObjectiveThe primary aim was to identify prototypical trajectories of SI in the general population and, secondarily, to examine whether receiving Web-based self-help for SI, psychiatric symptoms, or sociodemographics predicted membership in the identified SI trajectories.MethodsWe enrolled 236 people, from the general Dutch population seeking Web-based help for SI, in a randomized controlled trial comparing a Web-based self-help for SI group with a control group. We assessed participants at inclusion and at 2, 4, and 6 weeks. The Beck Scale for Suicide Ideation was applied at all assessments and was included in latent growth mixture modeling analysis to empirically identify trajectories.ResultsWe identified 4 SI trajectories. The high stable trajectory represented 51.7% (122/236) of participants and was characterized by constant high level of SI. The high decreasing trajectory (50/236, 21.2%) consisted of people with a high baseline SI score followed by a gradual decrease to a very low score. The third trajectory, high increasing (12/236, 5.1%), also had high initial SI score, followed by an increase to the highest level of SI at 6 weeks. The fourth trajectory, low stable (52/236, 22.0%) had a constant low level of SI. Previous attempted suicide and having received Web-based self-help for SI predicted membership in the high decreasing trajectory.ConclusionsMany adults experience high persisting levels of SI, though results encouragingly indicate that receiving Web-based self-help for SI increased membership in a decreasing trajectory of SI.

Depressive symptom trajectories in women affected by breast cancer and their male partners: a nationwide prospective cohort study.

The purpose of this study was to identify subgroups of breast cancer patients and their partners based on distinct trajectories of depressive symptoms, to examine how relationship quality and medical and sociodemographic factors were associated with these trajectories, and to explore whether patients and partners had similar trajectories. A nationwide, population-based cohort of couples dealing with breast cancer was established in Denmark. Participants completed the Center for Epidemiologic Studies-Depression Scale at baseline and 5 and 12months later. Sociodemographic and medical characteristics were retrieved from registers. A trajectory finite mixture model was used to identify trajectories. The trajectories of depressive symptoms over time were analyzed in 546 patients and 508 partners. Among patients, 13% had a high stable trajectory, 38% an intermediate decreasing trajectory, and 49% a low trajectory. Similar trajectories were found for partners (11, 22, and 67%, respectively). Compared to the low trajectory, trajectories with higher depressive symptoms were associated with poorer relationship quality and previous use of antidepressants for patients and partners and with younger age, comorbidity, basic education, and chemotherapy for patients. The trajectories of patients and their partners were weakly correlated. A considerable minority of patients and partners had a persistently high level of depressive symptoms. Poorer relationship quality and previous antidepressant use most consistently characterized patients and partners with higher depressive symptom trajectories. In clinical practice, attention to differences in depressive symptom trajectories is important to identify and target patients and partners who might need support.

Predicting Well-Being and Internalizing Symptoms in Late Adolescence From Trajectories of Externalizing Behavior Starting in Infancy.

This study aimed to examine the long-term prediction of well-being and internalizing symptoms from trajectories of externalizing behavior problems in 921 children from a population-based sample. We found that a high stable trajectory of externalizing behavior from infancy (age 1.5) to mid-adolescence (age 14.5) predicted lower scores on life satisfaction and flourishing for both girls and boys (age 18.5). The high stable trajectory also predicted higher levels of depressive symptoms in boys and anxiety symptoms in girls (age 18.5). The findings are noteworthy as they document how a person-oriented study of externalizing behavior problems starting in infancy can predict well-being and internalizing in late adolescence. The findings underline the importance of early health promotion and problem intervention efforts.

Emergent patterns of risk for psychopathology: The influence of infant avoidance and maternal caregiving on trajectories of social reticence.

The current study investigated the influential role of infant avoidance on links between maternal caregiving behavior and trajectories at risk for psychopathology. A sample of 153 children, selected for temperamental reactivity to novelty, was followed from infancy through early childhood. At 9 months, infant avoidance of fear-eliciting stimuli in the laboratory and maternal sensitivity at home were assessed. At 36 months, maternal gentle discipline was assessed at home. Children were repeatedly observed in the lab with an unfamiliar peer across early childhood. A latent class growth analysis yielded three longitudinal risk trajectories of social reticence behavior: a high-stable trajectory, a high-decreasing trajectory, and a low-increasing trajectory. For infants displaying greater avoidance, 9-month maternal sensitivity and 36-month maternal gentle discipline were both positively associated with membership in the high-stable social reticence trajectory, compared to the high-decreasing social reticence trajectory. For infants displaying lower avoidance, maternal sensitivity was positively associated with membership in the high-decreasing social reticence trajectory, compared to the low-increasing trajectory. Maternal sensitivity was positively associated with the high-stable social reticence trajectory when maternal gentle discipline was lower. These results illustrate the complex interplay of infant and maternal behavior in early childhood trajectories at risk for emerging psychopathology.

Long-term consequences of pubertal timing for youth depression: Identifying personal and contextual pathways of risk.

This research explored sex differences in the pathways linking pubertal timing to depression across 4 years. A sample of 167 youth (M age = 12.41 years, SD = 1.19) and their caregivers completed measures of puberty and semistructured interviews of interpersonal stress and youth depression. Youth reported on psychological (negative self-focus, anxious arousal) and social-behavioral (coping) characteristics; parents reported on youths' social-behavioral characteristics (withdrawal/social problems) and deviant peer affiliations. Early maturation predicted stable high trajectories of depression in girls; although early maturing boys showed low initial levels of depression, they did not differ from girls by the final wave of the study. Latent growth curve analyses identified several psychological, social-behavioral, and interpersonal pathways accounting for the contribution of pubertal timing to initial and enduring risk for depression in girls as well as emerging risk for depression in boys. These findings provide novel insight into multilevel processes accounting for sex differences in depression across the adolescent transition.

Long-term trajectories of maternal depressive symptoms and their antenatal predictors

BackgroundDepressive symptoms, often long-term or recurrent, are common among mothers of young children and a well-known risk for child well-being. We aimed to explore the antecedents of the long-term trajectories of maternal depressive symptoms and to define the antenatal factors predicting the high-symptom trajectories. MethodsThe sample comprised 329 mothers from maternity centers. Maternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) antenatally and at two months, six months, 4–5 years, 8–9 years and 16–17 years after delivery. Maternal expectations concerning the baby were assessed with the Neonatal Perception Inventory (NPI). Background information was gathered with questionnaires. ResultsA model including four symptom trajectories (very low, low-stable, high-stable and intermittent) was selected to describe the symptom patterns over time. The high-stable and the intermittent trajectory were both predicted pairwise by a high antenatal EPDS sum score as well as high EPDS anxiety and depression subscores but the other predictors were specific for each trajectory. In multivariate analyses, the high-stable trajectory was predicted by a high antenatal EPDS sum score, a high EPDS anxiety subscore, diminished life satisfaction, loneliness and more negative expectations of babies on average. The intermittent trajectory was predicted by a high antenatal EPDS sum score, a poor relationship with own mother and urgent desire to conceive. LimitationsOnly self-report questionnaires were used. The sample size was rather small. ConclusionsThe results suggest a heterogeneous course and background of maternal depressive symptoms. This should be considered in intervention planning.