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

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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).

LIMITATION:

Randomized trials are needed to further verify the feasibility of the model and the thresholds proposed.

CONCLUSION:

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%.

• Authors: Shu-Ting Yang, Si-Qi Yang, Kai-Ming Duan, Yong-Zhong Tang, An-Qi Ping, Zhi-Hong Bai, Kai Gao, Yang Shen, Ming-Hua Chen, Ri-Li Yu, Sai-Ying Wang
• Journal: Journal of affective disorders (J Affect Disord) Vol. 296 Pg. 434-442 (01 01 2022) ISSN: 1573-2517 [Electronic] Netherlands
• PMID: 34606808 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 Elsevier B.V. All rights reserved.

Topics

• Cesarean Section
• Cohort Studies
• Depression, Postpartum (epidemiology, prevention & control)
• Female
• Humans
• Pregnancy
• Retrospective Studies
• Risk Assessment
• Risk Factors