JMIR Publications

ABSTRACT

Background:

Postpartum depression (PPD) is a severe mental disorder that often results in poor maternal-infant attachment and negatively impacts infant development. Universal screening has recently been recommended to identify women at risk, but the optimal screening time during pregnancy has not been defined so far. Thus, web-based technologies with a widespread use among women of childbearing age create new opportunities to detect pregnancies with a high risk for adverse mental health outcomes at an early stage.

Objective:

The aim of the present study was to stratify the risk for PPD and to determine the optimal screening time during pregnancy by using a web-based screening tool collecting electronic patient-reported outcomes (ePRO) as the basis for a screening algorithm.

Methods:

214 women were repeatedly tested for depressive symptoms five times during and three times after pregnancy by using the Edinburgh Postnatal Depression Scale (EPDS), accessible on a web-based pregnancy platform, developed by the authors of the present study. For each prenatal assessment, the area under the curve (AUC), sensitivity, specificity, and predictive values for PPD were calculated. Multivariate logistic regression analyses were applied to identify further potential predictors such as age, education, parity, relationship quality and anxiety to increase predictive accuracy.

Results:

Digitally collected data from 214 pregnant women were analyzed. The predictive accuracy of depressive symptoms three and six months postpartum was reasonable to good regarding the screening in the second (AUC=.845) and third trimester (AUC=.752). The multivariate regression analyses resulted in an excellent AUC=.927 at three and a good AUC=.874 at six months postpartum. Limitations: The study group consisted of predominantly well-educated, married women.

Conclusions:

The best predictive accuracy for PPD has been shown for a screening between the 24th and 28th gestational week (GW) and seems to be beneficial for identifying women at risk. In combination with the aforementioned predictive factors, the discriminatory power improved, particularly at three months postpartum. A screening for depression during pregnancy combined with the women’s personal risk profile can be used as a starting point for developing a digital screening algorithm. Thereby web-based assessment tools constitute feasible, efficient and cost-effective approaches. Thus, they seem to be beneficial in detecting high risk pregnancies in order to improve maternal and infant birth outcomes in the long term.