Predictive Models for Predicting the Risk of Maternal Postpartum Depression: A Systematic Review and Evaluation

Objectives: Clinical prediction models have been widely used to screen and diagnose postpartum depression (PPD). This study systematically reviews and evaluates the risk of bias and the applicability of PPD prediction models. Methods: A systematic search was performed in eight databases from inception to June 1, 2022. The literature was independently screened, and data were extracted by two investigators using the checklist for critical appraisal and data extraction for systematic reviews of prediction modeling studies (CHARMS). The risk of bias and applicability was assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Results: After the screening, 12 studies of PPD risk prediction models were included, with the area under the ROC curve of the models ranging from 0.611 to 0.937. The most-reported predictors of PPD included several aspects, including prenatal mood disorders, endocrine and hormonal influences, psychosocial aspects, the influence of family factors, and somatic illness factors. The applicability of all studies was good. However, there was some bias, mainly due to inadequate outcome events, missing data not appropriately handled, lack of model performance assessment, and overfitting of the models. Conclusions: This systematic review and evaluation indicate that most present PPD prediction models have a high risk of bias during development and validation. Despite some models' predictive solid performance, the models' clinical practice rate is low. Therefore, future research should develop predictive models with excellent performance in all aspects and clinical applicability to better inform maternal medical decisions.