The development and application of a prediction model for postpartum depression: optimizing risk assessment and prevention in the clinic

• Published in: Journal of affective disorders 2022-01, Vol.296, p.434-442
• Main Authors: Yang, Shu-Ting, Yang, Si-Qi, Duan, Kai-Ming, Tang, Yong-Zhong, Ping, An-Qi, Bai, Zhi-Hong, Gao, Kai, Shen, Yang, Chen, Ming-Hua, Yu, Ri-Li, Wang, Sai-Ying
• Format: Article
• Language: English
• Subjects: Cesarean Section; Cohort Studies; Depression, Postpartum - epidemiology; Depression, Postpartum - prevention & control; Female; Humans; Postpartum depression; Prediction model; Pregnancy; Preventive intervention; Retrospective Studies; Risk Assessment; Risk Factors; Risk threshold
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2021.09.099

•We conducted a new prediction model with a combination of prenatal risk factors to assess the risk probability of postpartum depression (PPD).•The prediction model better defines the high-risk PPD population with a 19% risk threshold.•Ketamine intervention significantly lowers PPD incidence in high-risk parturients. Preventive intervention can significantly reduce the human and economic costs of postpartum depression (PPD) compared with treatment post-diagnosis. However, identifying women with a high PPD risk and making a judgement as to the benefits of preventive intervention is a major challenge. This is a retrospective study of parturients that underwent a cesarean delivery. Control group was used as development cohort and validation cohort to construct the risk prediction model of PPD and determine a risk threshold. Ketamine group and development cohort were used to verify the risk classification of parturients by evaluating whether the incidence of PPD decreased significantly after ketamine treatment in high-risk for PPD population. The AUC for the development cohort and validation cohort of the PPD prediction model were 0.751 (95%CI:0.700-0.802) and 0.748 (95%CI:0.680-0.816), respectively. A threshold of 19% PPD risk probability was determined, with a specificity and sensitivity in the validation cohort are 0.766 and 0.604, respectively. After matching the high-risk group and the low-risk group by propensity score, the results demonstrated that PPD incidence significantly reduced in the high-risk group following ketamine, versus non-ketamine, intervention (p < 0.01). In contrast, intervention in the low-risk group showed no significant difference in PPD outcomes (p > 0.01). Randomized trials are needed to further verify the feasibility of the model and the thresholds proposed. This prediction model developed in this study shows utility in predicting PPD risk. Ketamine intervention significantly lowers PPD incidence in parturients with a risk classification threshold greater than 19%.