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Algorithm predicts trajectory, severity of postpartum depressive symptoms

Researchers were able to determine whether new mothers would experience worsening depressive symptoms in the first year after birth by identifying four maternal characteristics — parity, education, global functioning and depression severity, according to study findings.

“Elucidation of the course of symptom severity, or trajectories, experienced by postpartum women is essential because the period prevalence of clinically significant depression is a striking 21.9% across the first postpartum year, with 800,000 women affected annually,” Sheehan D. Fisher, PhD, assistant professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine, and colleagues wrote. “Early identification of phenotypes and tailored treatments have potential to reduce the multigenerational risks of prolonged maternal depression on child and family outcomes.”

In this longitudinal prospective cohort study, researchers reported the 12month trajectories of postpartum depressive symptoms and identified characteristics that predict these trajectories using a computational algorithm.

In total, 507 women with postpartum depression completed symptom severity assessments at 4 to 8 weeks, 3 months, 6 months and 12 months. Participants also answered questions regarding depressive symptom severity, medical history, assessment of function, obstetric experience and infant status during clinician interviews.

"It's not just a question of 'Is the mother feeling depressed?' but rather, 'Which way is she headed in her depression?'" Fisher said in a press release. "If her depression symptoms are going to get worse over time, she needs to be proactive about treatment."

Three distinct trajectories of postpartum depressive symptoms were identified among participants: gradual remission (50.4%), partial improvement (41.8%) and chronic severe (7.8%). The results showed that the key predictive characteristics relating to having chronic severe depression vs. having gradual remission and partial improvement trajectories were parity, education, current global functioning and baseline depression severity.

In addition, the algorithm was able to predict trajectory membership with 72.8% accuracy from these characteristics, according to the findings.

"By the time a mother comes in for her 6-week postpartum visit, we have the potential to predict the severity of her depression over the next 12 months," Fisher said in the release. "This would be a game-changer for mothers and their clinicians because we could encourage early intervention, so moms have better odds of success with their treatment over time."

In the full study, the investigators wrote that using this algorithm could support psychiatric stepped care approaches that get women individualized treatment based on characteristics detected early in the postpartum period if validated in future research. Along with U.S. Preventive Services Task Force’s recommendation to screen perinatal women for depression, clinicians can use these models to match the level of care to a patient’s projected trajectory, Fisher and colleagues wrote. – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.