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Postpartum depression in primiparas: Association with rooming-in implementation quality and an exploratory nomogram

Year: 2026

Type: article

Abstract: BACKGROUND Postpartum depression (PPD) is a common psychiatric complication of the postpartum period and is associated with adverse maternal and infant outcomes.Rooming-in is a core component of postpartum care, but the association between the quality of its implementation and PPD has been insufficiently characterized.Because rooming-in quality and several psychosocial measures in this study were assessed at the same 6week postpartum visit as PPD status, the present analysis should be interpreted as exploratory rather than causal or temporally predictive.AIM To examine the association between rooming-in implementation quality and PPD status among primiparous women and to derive an internally validated exploratory multivariable classification nomogram.METHODS This single-center retrospective case-control study analyzed 298 primiparous women who delivered between January 2022 and December 2024, including 153 PPD cases [Edinburgh Postnatal Depression Scale (EPDS) ≥ 13 at 6 weeks] and 145 low-EPDS controls (EPDS ≤ 8).Women with intermediate EPDS scores of 9-12 were not included in the analytic sample.Controls were selected to achieve group-level comparability in age and delivery mode; no individual matched pairs were used.Prenatal EPDS was obtained during the third trimester, whereas the study-specific Rooming-in Implementation Score (RIS), Pittsburgh Sleep Quality Index (PSQI), Social Support Rating Scale (SSRS), Self-Rating Anxiety Scale (SAS), and postpartum EPDS were assessed at the 6-week visit.RIS was completed retrospectively by maternal self-report.Logistic regression was used to derive an exploratory model, with 1000-iteration 4 / 31 bootstrap internal validation.Because case-control sampling fixed the outcome proportion, predicted absolute probabilities, positive predictive value, negative predictive value, and decision thresholds were interpreted as sample-specific rather than population-calibrated risk estimates.RESULTS The PPD group had a lower RIS score than the control group (57.6 ± 12.8 vs 77.2 ± 10.5, P < 0.001).Five variables remained in the final multivariable model: RIS score [odds ratio (OR) = 0.74, 95% confidence interval (CI): 0.62-0.88],prenatal EPDS score (OR = 1.19, 95%CI: 1.11-1.28),SSRS total score (OR = 0.93, 95%CI: 0.89-0.97),PSQI score (OR = 1.23, 95%CI: 1.14-1.33),and SAS standard score (OR = 1.13, 95%CI: 1.06-1.20).The apparent area under the curve (AUC) was 0.881 (95%CI: 0.845-0.917),and the bootstrap-corrected AUC was 0.863.Calibration within the selected sample was acceptable (Hosmer-Lemeshow χ 2 = 7.524, P = 0.481), although calibration and decision-curve thresholds cannot be generalized directly to an unselected postpartum population.CONCLUSION Lower rooming-in implementation quality was associated with PPD case status in this selected retrospective sample.The internally derived nomogram showed promising discrimination, but RIS, PSQI, SSRS, and SAS were measured concurrently with the 6week outcome and RIS was recall-dependent.The model should therefore be considered hypothesis-generating and requires prospective, temporally ordered external validation and population recalibration before clinical risk prediction or implementation.

Source: World Journal of Psychiatry

DOI: 10.5498/wjp.125137

Authors: Fang-Fang Li, Qing-Xia Lin, Shu-Shi Ye, Jing Li

Institutions: Wenzhou Medical University, First Affiliated Hospital of Wenzhou Medical University

Language: English

Topic: Maternal Mental Health During Pregnancy and Postpartum

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W7225126922

FWCI:

Cites: 20

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Related to: 10