Clinical index to quantify the 1-year risk for common postpartum mental disorders at the time of delivery (PMH CAREPLAN): development and internal validation

• Published in: British journal of psychiatry Vol. 223; no. 3; pp. 422 - 429
• Main Authors: Vigod, Simone N., Urbach, Natalie, Calzavara, Andrew, Dennis, Cindy-Lee, Gruneir, Andrea, Thombs, Brett D., Walker, Mark, Brown, Hilary K.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.09.2023
• Subjects: Antidepressants; Anxiety; Avoidable; Birth; Birth records; Breastfeeding & lactation; Childbirth & labor; Clinical medicine; Discrimination; Emergency medical care; Emergency services; Extremes; Female; Gestational age; Health services; Hospitalization; Hospitals; Humans; Immigration policy; Individual differences; Infant, Newborn; Intervention; Lactation; Medical diagnosis; Medical personnel; Memory; Mental disorders; Mental Disorders - epidemiology; Mental Disorders - psychology; Mental Health; Mental health care; Mental health professionals; Ontario - epidemiology; Perinatal; Post traumatic stress disorder; Postpartum; Postpartum depression; Postpartum Period; Prediction models; Pregnancy; Prenatal care; Psychiatry; Psychotic Disorders; Regression analysis; Risk assessment; Risk reduction; Sociodemographics; Ontario; Canada; Ontario Canada; anxiety; predictive model; depression; Postpartum; risk index
• ISSN: 0007-1250; 1472-1465
• DOI: 10.1192/bjp.2023.74

Common postpartum mental health (PMH) disorders such as depression and anxiety are preventable, but determining individual-level risk is difficult. To create and internally validate a clinical risk index for common PMH disorders. Using population-based health administrative data in Ontario, Canada, comprising sociodemographic, clinical and health service variables easily collectible from hospital birth records, we developed and internally validated a predictive model for common PMH disorders and converted the final model into a risk index. We developed the model in 75% of the cohort ( = 152 362), validating it in the remaining 25% ( = 75 772). The 1-year prevalence of common PMH disorders was 6.0%. Independently associated variables (forming the mnemonic PMH CAREPLAN) that made up the risk index were: (P) prenatal care provider; (M) mental health diagnosis history and medications during pregnancy; (H) psychiatric hospital admissions or emergency department visits; (C) conception type and complications; (A) apprehension of newborn by child services (newborn taken into care); (R) region of maternal origin; (E) extremes of gestational age at birth; (P) primary maternal language; (L) lactation intention; (A) maternal age; (N) number of prenatal visits. In the index (scored 0-39), 1-year common PMH disorder risk ranged from 1.5 to 40.5%. Discrimination (C-statistic) was 0.69 in development and validation samples; the 95% confidence interval of expected risk encompassed observed risk for all scores in development and validation samples, indicating adequate risk index calibration. Individual-level risk of developing a common postpartum mental health disorder can be estimated with data feasibly collectable from birth records. Next steps are external validation and evaluation of various cut-off scores for their utility in guiding postpartum individuals to interventions that reduce their risk of illness.