Using risk factors to prevent postpartum mental health disorders
Postpartum mental health disorders like anxiety and depression can have devastating effects on the wellbeing of parent and child alike.
Stopping postpartum mental health disorders before they start would not only avoid the suffering they cause but prevent their long-term impacts on mental health. But to prevent these disorders, we need to predict them.
Dr. Simone Vigod and her team, including Drs. Hilary K. Brown and Cindy-Lee Dennis, have been studying the risk factors for these disorders. The Institute for Clinical Evaluative Sciences (ICES) provided the team with information about Ontario patients. They used these data to create an index designed to predict the risk of developing a postpartum mental health disorder and allow caregivers to take action to prevent them before they start.
Why is it important to create a risk index for common postpartum mental health disorders?
SV: We have methods that can prevent postpartum mental health disorders such as depression or anxiety. However, these methods seem to be more effective for people who are at a high risk of developing these disorders. Preventative treatments have costs and downsides. They can be time consuming and expensive, and they may have side effects. If we know how likely it is that someone will develop a postpartum mental disorder, it can help them weigh the potential risks and benefits of treatment.
What motivated this research?
SV: Even though we know in general what the “risk factors” are for developing a postpartum mental disorder, we don’t have a way to combine all the risk factors together and give a person an estimate of what their overall risk is.
In Ontario, obstetrical care providers submit information about health and demographics with a group called the Better Outcomes Registry Network (BORN). BORN connects this information with other health records to keep track of what happens to people after they give birth, including if they are diagnosed with a postpartum mental disorder. This provided us with the opportunity to see if we could create a “risk estimate” for people based on data from our whole population.
What was the most important finding of this study, in your opinion?
SV: Using a small number of variables collected from a person’s medical chart, we can predict whether they will develop a common postpartum mental disorder with about 70% accuracy – and we can give them an estimate of the probability that they will develop a mental disorder at the time that they give birth.
While this is not a perfect prediction – which we wouldn’t expect, because lots of things happen after the birth of a baby that might change a person’s trajectory – it is a major improvement in our ability to inform people about their personal risk of developing a disorder.
What are the next steps and how will they shape future treatment?
SV: The most important next step is to see how this “risk index” works for other populations and in other regions. Then, we want to determine at what level of risk it becomes beneficial to provide a preventive intervention like psychotherapy or medication.
What is the major take home message for the public?
SV: We are improving our ability to make personalized risk predictions for postpartum mental health disorders. Given how common postpartum mental illness has become, even preventing a small percentage of people from developing a disorder can result in many people avoiding a great deal of suffering.
ImPACT Committee includes Krista Lanctôt, Alastair Flint, Meng-Chuan Lai and Simone Vigod.
Simone N Vigod, Natalie Urbach, Andrew Calzavara, Cindy-Lee Dennis, Andrea Gruneir, Brett D Thombs, Mark Walker, Hilary K Brown. Clinical index to quantify the 1-year risk for common postpartum mental disorders at the time of delivery (PMH CAREPLAN): development and internal validation. Br J Psychiatry. 2023 Sep:223(3):422-429. doi: 10.1192/bjp.2023.74.
