P1-234 Prenatal screening for suboptimal mental health in the postpartum period

Abstract

Postpartum depression (PPD) is the most common complication of pregnancy in developed countries, affecting 10-15% of all new mothers. There has been a shift in thinking less in terms of PPD per se to poor psychosocial outcomes and difficulties transitioning to the parenting role after giving birth. The objective of this study was to develop a screening tool that identifies women at risk of distress in the postpartum period using information collected prenatally.We used data collected for the All Our Babies Study, a prospective cohort study of pregnant women living in Alberta, Canada (N = 1578) that collects a diverse array of information at three time points during the perinatal period. We developed the tool using 2/3 of the sample and performed internal validation on the remaining 1/3. Using a regression coefficient- based scoring method, we developed an integer score-based prediction rule for the prevalence of PPD at 4 months postpartum.We calculated the sensitivity, specificity, likelihood ratios for positive and negative predictive values, and area under the ROC curve by varying the threshold of our screening score for optimal discrimination. The best fit model included known risk factors for PPD and suboptimal psychosocial health: depression and stress in late pregnancy, history of abuse, and poor relationship quality with partner. The area under the ROC curve was 0.76, with acceptable sensitivity and specificity for a cut-off score of 2 (range 0 - 7). Comparison of the tool with a widely used PPD screening inventory showed that our tool had better performance indicators. Further validation of our tool for psychosocial distress was seen in its utility for identifying symptoms of anxiety, in addition to depression, at 4 months.