Certain factors predict postnatal depression after C-section

Among pregnant women undergoing caesarean delivery under neuraxial anaesthesia in Singapore, the likelihood of postnatal depression may be predicted using five preoperative psychological and analgesic factors, according to a study.

Higher preoperative Central Sensitization Inventory scores (p=0.0156), higher anxiety levels about upcoming surgery (p=0.0429), increased preoperative pain scores on movement (p=0.0110), higher preoperative Hospital Anxiety and Depression Scale subscale scores on anxiety (p=0.0041), and lower anticipation of pain medication needs (p=0.0038) were all independently associated with the incidence of postnatal depression (Edinburgh Postnatal Depression Scale score ≥10) at 6 to 10 weeks after caesarean delivery. [Neuropsychiatr Dis Treat 2024:20:439-447]

At a cutoff point of 0.209, a model that included all five factors was able to predict postnatal depression in the training cohort with an accuracy of 76.24 percent (95 percent confidence interval [CI], 69.76–81.93), sensitivity of 76.19 percent (95 percent CI, 60.55–87.95), specificity of 76.25 percent (95 percent CI, 68.89–82.61), and area under curve (AUC) of 0.785 (95 percent CI, 0.707–0.864).

Using the same cutoff in the validation cohort, the model had an accuracy of 74.44 percent (95 percent CI, 67.42–80.64), sensitivity of 70.6 percent (95 percent CI, 52.52–84.90), specificity of 75.34 percent (95 percent CI, 67.53–82.09), and AUC of 0.724 (95 percent CI, 0.644–0.815).

The training cohort included were 205 parturients (mean age 34.6 years, 60.5 percent Chinese), with an overall prevalence of postnatal depression of 21.1 percent at 6 to 10 weeks after caesarean delivery. Meanwhile, the validation cohort included 180 patients (mean age 32.7 years, 52.8 percent Chinese), with an overall postnatal depression prevalence of 18.9 percent.

“Similar to the results of a previous study, our study identified the same five covariates that are independently associated with the development of postnatal depression,” according to the investigators. [Neuropsychiatr Dis Treat 2020;16:715-727]

Our validated model allows for the identification of women at high risk, enabling closer monitoring and earlier intervention strategies, they added.

While the findings are promising, the study had some limitations that need to be considered when interpreting the results, the investigators said.

First, the study was conducted in an Asian population predominantly of Chinese ethnicity, with the population being limited to women who underwent caesarean deliveries under neuraxial anaesthesia. The investigators stressed that Asian populations may be less likely to report mood symptoms due to the social stigma surrounding mental health issues. [Psychiatry 2008;71:210-218]

Additionally, the study only followed up with participants for 6 to 10 weeks postpartum, whereas research suggests that postnatal depression can occur anytime within the first year after delivery, they added.

The investigators called for further research to determine whether the model is applicable in different social and cultural contexts.