Abstract
BACKGROUND: Existing research on perinatal psychopathology has often focused on categorical disorders, overlooking the high prevalence of comorbidity and polysubstance use. The current study aims to identify distinct profiles of perinatal psychopathology and substance use, explore socioeconomic influences on psychopathology presentations, and characterize patterns of substance exposure (lifetime/perinatal) across psychopathology profiles. METHODS: This study used data from the HEALthy Brain and Child Development (HBCD) study, a large and representative U.S. cohort (n = 1425 participants). Maternal psychopathology symptoms were derived using the DSM-5 Cross-Cutting Symptom Measure (CCSM) and lifetime/perinatal substance use was measured using an adapted version of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). RESULTS: Latent analyses identified four psychopathology profiles (Asymptomatic, Subthreshold, Clinical, and Clinical High-Risk), reflecting increasing symptom severity across them. Lower education and income levels were significantly associated with the two highest risk profiles. Two lifetime substance use profiles emerged: a lower risk profile characterized by alcohol and cannabis use, and a higher risk profile with broader polysubstance use. Both the Clinical (OR = 2.023, p < .001) and Clinical High-Risk (OR = 2.708, p = .001) psychopathology profiles had elevated odds of high-risk lifetime polysubstance use, and of perinatal use across all substances (ps < 0.05). CONCLUSIONS: Findings suggest that perinatal psychopathology may be better captured by multidimensional profiles. More severe profiles were linked with lower socioeconomic status and increased lifetime and perinatal substance exposure. These findings emphasize the need for integrated mental health, substance use, and socioeconomic supports during the perinatal period.