Neuropsychiatric Disease and Treatment (Feb 2024)

Investigating Factors Associated with the Development of Postnatal Depression After Cesarean Delivery: A Validation Cohort Study

  • Tan DJA,
  • Sultana R,
  • Chow SYX,
  • Tan CW,
  • Tan HS,
  • Chen HY,
  • Chua TE,
  • Sng BL

Journal volume & issue
Vol. Volume 20
pp. 439 – 447

Abstract

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Daryl Jian An Tan,1 Rehena Sultana,2 Sheryl Yu Xuan Chow,3 Chin Wen Tan,1,4 Hon Sen Tan,1,4 Helen Yu Chen,5,6 Tze-Ern Chua,5,6 Ban Leong Sng1,4 1Department of Women’s Anesthesia, KK Women’s and Children’s Hospital, Singapore, Singapore; 2Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore; 3Duke-NUS Medical School, Singapore, Singapore; 4Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore; 5Department of Psychological Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore; 6Paediatrics Academic Clinical Program, Duke-NUS Medical School, Singapore, SingaporeCorrespondence: Chin Wen Tan, Department of Women’s Anesthesia, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, Singapore, Tel +65 6394 6486, Fax +65 62912661, Email [email protected]: This study aimed to validate a proposed association model previously published to determine the clinical relevance of pre-operative determinants in the development of PND after Cesarean delivery (CD).Patients and Methods: Parturients undergoing elective CD under neuraxial anesthesia were recruited for a prospective cohort study between Oct 2021 and Oct 2022 at KK Women’s and Children’s Hospital, Singapore. Predelivery pain, psychological and mechanical temporal summation, and demographic data were recorded. A follow-up survey was conducted at 6 to 10 weeks after CD. The primary outcome was the incidence of PND, defined as an Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10.Results: A total of 180 patients were recruited for validation. PND 6 to 10 weeks post-delivery occurred in 18.9% of recruited parturients. Multivariate regression analyses showed that higher pre-operative CSI scores (p=0.0156), higher anxiety levels about upcoming surgery (p=0.0429), increased pre-operative pain scores on movement (p=0.0110), and higher pre-operative HADS subscale scores on anxiety (p=0.0041) were independently associated with the development of PND weeks post-CD. Lower anticipation of pain medication needs (p=0.0038) was independently associated with the development of PND post-CD. The area under curve (AUC) of this multivariable model (training cohort), internal cross validation (training cohort) and external cross validation (validation cohort) were 0.818 (95% CI, 0.746 to 0.889), 0.785 (95% CI, 0.707 to 0.864) and 0.604 (95% CI, 0.497 to 0.710) respectively.Conclusion: The proposed model performed well in a local population. Further refinement is necessary to test the proposed model in populations with social and cultural differences.Keywords: anxiety, obstetrics, pain, postnatal depression

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