Postpartum depression: a developed and validated model predicting individual risk in new mothers
Open accessAbstract
Postpartum depression (PPD) is a serious condition associated with potentially tragic outcomes, and in an ideal world PPDs should be prevented. Risk prediction models have been developed in psychiatry estimating an individual’s probability of developing a specific condition, and recently a few models have also emerged within the field of PPD research, although none are implemented in clinical care. For the present study we aimed to develop and validate a prediction model to assess individualized risk of PPD and provide a tentative template for individualized risk calculation offering opportunities for additional external validation of this tool. Danish population registers served as our data sources and PPD was defined as recorded contact to a psychiatric treatment facility (ICD-10 code DF32-33) or redeemed antidepressant prescriptions (ATC code N06A), resulting in a sample of 6,402 PPD cases (development sample) and 2,379 (validation sample). Candidate predictors covered background information including cohabitating status, age, education, and previous psychiatric episodes in index mother (Core model), additional variables related to pregnancy and childbirth (Extended model), and further health information about the mother and her family (Extended+ model). Results indicated our recalibrated Extended model with 14 variables achieved highest performance with satisfying calibration and discrimination. Previous psychiatric history, maternal age, low education, and hyperemesis gravidarum were the most important predictors. Moving forward, external validation of the model represents the next step, while considering who will benefit from preventive PPD interventions, as well as considering potential consequences from false positive and negative test results, defined through different threshold values.
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All prior studies predicting PPD have found that varying aspects of mental health history are the strongest predictors of PPD.
“Consistent with our findings, all prior studies predicting PPD have found that varying aspects of mental health history (i.e., anxiety disorders and prenatal EPDS score [53]; depression and anxiety history, recent psychiatric medication use [54]; psychiatric history [55]; anxiety, depression, and antidepressants during pregnancy [56]) are the strongest predictors of PPD.”
From Factors associated with postpartum depression symptoms following antepartum hospitalization (2026) · cites this paper as [55]
The Discussion (‘Prediction of PPD risk’; page unavailable) says several earlier studies found depression and anxiety history to be among the most important predictors. The paper also identifies psychiatric history as one of its own most important predictors, alongside maternal age, education, and hyperemesis gravidarum. It does not establish that all prior studies found mental health history to be the strongest predictor. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPrior studies predicting PPD risk have achieved AUCs of 0.80-0.90.
“Prior studies predicting PPD risk have achieved further improved discriminatory ability (AUCs of 0.80–0.90) but have limitations related to generalizability [54, 55] and the finding that history of depression drives much of the discriminatory performance [54, 56].”
From Factors associated with postpartum depression symptoms following antepartum hospitalization (2026) · cites this paper as [55]
The Discussion section, “Prediction of PPD risk” (page unavailable), reports that prior PPD prediction studies achieved AUCs of 0.81–0.93. This supports the claim that prior studies reached AUCs around 0.80–0.90, but the stated range omits results above 0.90. (LLM, conf=0.85)
Experimental — accuracy not yet measuredPrior studies predicting PPD risk have limitations related to generalizability.
“Prior studies predicting PPD risk have achieved further improved discriminatory ability (AUCs of 0.80–0.90) but have limitations related to generalizability [54, 55] and the finding that history of depression drives much of the discriminatory performance [54, 56].”
From Factors associated with postpartum depression symptoms following antepartum hospitalization (2026) · cites this paper as [55]
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Factors associated with postpartum depression symptoms following antepartum hospitalization
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- Authors
- Munk-Olsen, T., Liu, X., Madsen, K. B., Kjeldsen, M.-M. Z., Petersen, L. V., Bergink, V., Skalkidou, A., Vigod, S. N., Frokjaer, V. G., Pedersen, C. B., & Maegbaek, M. L.
- Affiliations
- Aarhus University (DK)
- Erasmus MC (NL)
- Uppsala University (SE)
- University of Toronto (CA)
- ORCID
- Venue
- Translational Psychiatry
- Published
- 2022-09-30
- Volume
- 12
- Issue
- 1
- Pages
- 419-419
- ISSN
- 2158-3188 (ISSN-L)
- PMC
- PMC9525696
- OpenAlex
- W4298140395
- Cited by
- 36
- References
- 54
- Citations by year
- 2026: 10 · 2025: 10 · 2024: 10 · 2023: 4 · 2022: 2
- FWCI
- 5.73
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Translational Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, cc-by)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Uppsala University Publications (Uppsala University) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, cc-by)
- Funders
- Marie Curie (891079)
- European Commission (HORIZON2020, 891079)
- Lundbeckfonden (R313-2019-569)
- Vetenskapsrådet (2020-01965)
- H. Lundbeck A/S
- National Institute of Mental Health (R01MH122869)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Keywords
- postpartum depression, risk prediction model, individual risk assessment, postpartum women, hyperemesis gravidarum, maternal psychiatric history, maternal age, educational attainment, pregnancy and childbirth, antidepressant prescribing, psychiatric treatment utilization, discrimination and calibration, postpartum depression prevention
- MeSH terms
- Antidepressive Agents, Female, Humans, Mothers, Pregnancy, Risk Factors, Depression, Postpartum
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