///2019 Abstract Details
2019 Abstract Details2019-07-13T07:45:15-05:00

A Novel Scale for Evaluation of Postpartum Depression (PPD): An Insight through Validation of PPD Using Combined Score

Abstract Number: F310-513
Abstract Type: Original Research

Jie Zhou MD, MS, MBA, FASA1 ; Danran Zhou BS2; Huihui Zhu MD3; Min Wei MD4

Background

Postpartum depression (PPD) particularly refers to the depression that occurs after childbirth. Our research group has been working on this subject for a few years. We often encountered problems of different PPD scales with no interoperability. In this study, we compared PPD parturients in subgroups with different scales of evaluation, explored potential conversion and combination and identified possible risk factors that could influence the severity of PPD.

Methods

Retrospective chart review of PPD parturients at Brigham and Women’s Hospital between 1/1/2015 to 12/31/2018 were conducted. Demographic information, diagnosis, delivery and analgesia procedure were collected. Since Edinburgh postnatal depression scale (EDPS) and Patient Health Questionnaire (PHQ-9) are most used to evaluate PPD severity with similar severity ranges and maximum scores (30 and 27 respectively), we combined these two scores as a new measurement called Combined score (C-score). We divided the PPD parturients into three subgroups using the C-score: 1. Mild (0-8); 2. Moderate (8-12); and 3. Severe (13-15 and above). Other potential risk factors used as independent variables included mental history, body mass index (BMI), thyroid function, weeks of gestation, Para, and delivery methods. Ordinal Logistic Regression analysis was used for analyzing associations and interactions among these independent variables and C-score.

Results

A total 240 PPD cases were identified. A scatterplot showed the PHQ-9 score and EDPS score were strongly positively correlated. This supports our derived measurement for C-score. A proportional odds model for ordinal outcomes is fitted to test the association between the risk factors and the newly derived C-score. Our results indicate: there was a positive association between the Body Mass Index (BMI) and C-score (p=0.11); parturients with Major Depression Disorder (MDD) history had higher C-score (p=0.20) than Parturients with Generalized Anxiety Disorder (GAD) history (p=0.31); particularly, parturients with both MDD and GAD history tended to be more vulnerable to PPD (p=0.05). When Para was larger than 1, C-score was significantly lower than when Para was 1 (p=0.04).

Discussion

In the United States, there is no separate diagnosis criterion for PPD, but it follows the criteria for MDD, based on the diagnostic and statistical manual of mental disorder (DSM-5). Moreover, the international classification of diseases 10 (ICD-10) does not recognize PPD as a separate diagnosis. However, PPD has specificity related to female hormone changes during pregnancy. The combination of EDPS and PHQ-9 scores suggests a possible way to design a universal diagnosis criterion for PPD.

Reference

McCabe-Beane JE, et al. J Reprod Infant Psych 2016

SOAP 2019