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States Transitions Inference of Postpartum Depression Based on Multi-State Markov Model

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  • Juan Xiong

    (Health Science Center, Shenzhen University, Shenzhen 518060, China)

  • Qiyu Fang

    (Health Science Center, Shenzhen University, Shenzhen 518060, China)

  • Jialing Chen

    (Health Science Center, Shenzhen University, Shenzhen 518060, China)

  • Yingxin Li

    (Health Science Center, Shenzhen University, Shenzhen 518060, China)

  • Huiyi Li

    (Health Science Center, Shenzhen University, Shenzhen 518060, China)

  • Wenjie Li

    (Health Science Center, Shenzhen University, Shenzhen 518060, China)

  • Xujuan Zheng

    (Health Science Center, Shenzhen University, Shenzhen 518060, China)

Abstract

Background : Postpartum depression (PPD) has been recognized as a severe public health problem worldwide due to its high incidence and the detrimental consequences not only for the mother but for the infant and the family. However, the pattern of natural transition trajectories of PPD has rarely been explored. Methods: In this research, a quantitative longitudinal study was conducted to explore the PPD progression process, providing information on the transition probability, hazard ratio, and the mean sojourn time in the three postnatal mental states, namely normal state, mild PPD, and severe PPD. The multi-state Markov model was built based on 912 depression status assessments in 304 Chinese primiparous women over multiple time points of six weeks postpartum, three months postpartum, and six months postpartum. Results : Among the 608 PPD status transitions from one visit to the next visit, 6.2% (38/608) showed deterioration of mental status from the level at the previous visit; while 40.0% (243/608) showed improvement at the next visit. A subject in normal state who does transition then has a probability of 49.8% of worsening to mild PPD, and 50.2% to severe PPD. A subject with mild PPD who does transition has a 20.0% chance of worsening to severe PPD. A subject with severe PPD is more likely to improve to mild PPD than developing to the normal state. On average, the sojourn time in the normal state, mild PPD, and severe PPD was 64.12, 6.29, and 9.37 weeks, respectively. Women in normal state had 6.0%, 8.5%, 8.7%, and 8.8% chances of progress to severe PPD within three months, nine months, one year, and three years, respectively. Increased all kinds of supports were associated with decreased risk of deterioration from normal state to severe PPD (hazard ratio, HR: 0.42–0.65); and increased informational supports, evaluation of support, and maternal age were associated with alleviation from severe PPD to normal state (HR: 1.46–2.27). Conclusions: The PPD state transition probabilities caused more attention and awareness about the regular PPD screening for postnatal women and the timely intervention for women with mild or severe PPD. The preventive actions on PPD should be conducted at the early stages, and three yearly; at least one yearly screening is strongly recommended. Emotional support, material support, informational support, and evaluation of support had significant positive associations with the prevention of PPD progression transitions. The derived transition probabilities and sojourn time can serve as an importance reference for health professionals to make proactive plans and target interventions for PPD.

Suggested Citation

  • Juan Xiong & Qiyu Fang & Jialing Chen & Yingxin Li & Huiyi Li & Wenjie Li & Xujuan Zheng, 2021. "States Transitions Inference of Postpartum Depression Based on Multi-State Markov Model," IJERPH, MDPI, vol. 18(14), pages 1-11, July.
  • Handle: RePEc:gam:jijerp:v:18:y:2021:i:14:p:7449-:d:593103
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    References listed on IDEAS

    as
    1. Cecilia Peñacoba Puente & Carlos Suso-Ribera & Sheila Blanco Rico & Dolores Marín & Jesús San Román Montero & Patricia Catalá, 2021. "Is the Association between Postpartum Depression and Early Maternal–Infant Relationships Contextually Determined by Avoidant Coping in the Mother?," IJERPH, MDPI, vol. 18(2), pages 1-14, January.
    2. Verónica Martínez-Borba & Carlos Suso-Ribera & Jorge Osma & Laura Andreu-Pejó, 2020. "Predicting Postpartum Depressive Symptoms from Pregnancy Biopsychosocial Factors: A Longitudinal Investigation Using Structural Equation Modeling," IJERPH, MDPI, vol. 17(22), pages 1-15, November.
    3. Abel Fekadu Dadi & Emma R Miller & Lillian Mwanri, 2020. "Antenatal depression and its association with adverse birth outcomes in low and middle-income countries: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-23, January.
    4. Qun Wang & Yao Zhang & Xilin Li & Ziwen Ye & Lingling Huang & Yan Zhang & Xujuan Zheng, 2021. "Exploring Maternal Self-Efficacy of First-Time Mothers among Rural-to-Urban Floating Women: A Quantitative Longitudinal Study in China," IJERPH, MDPI, vol. 18(6), pages 1-12, March.
    5. Wenjie Gong & Xin Jin & Kar Keung Cheng & Eric D. Caine & Richard Lehman & Dong (Roman) Xu, 2020. "Chinese Women’s Acceptance and Uptake of Referral after Screening for Perinatal Depression," IJERPH, MDPI, vol. 17(22), pages 1-11, November.
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