Background and Aims This study aimed to validate a predictive model of postpartum depression in patients having undergone Caesarean delivery to determine clinical relevance of pre-operative determinants for post-Caesarean pain management.

Methods Parturients undergoing Caesarean delivery and requiring regional anaesthesia were recruited. Pre-delivery pain and anxiety assessment were conducted via pain scoring, mechanical temporal summation assessment and questionnaires. Outcome on incidence of postpartum depression is defined as having an Edinburgh Postpartum Depression Scale (EPDS) score of 10 or more. Other information on pain scores, analgesia consumption, opioid-related side effects, and patient satisfaction were also collected.

Results In this validation study, postpartum depression at 6 to 10 weeks post-delivery occurred in 18.9% (34 of 180) of patients who underwent elective Caesarean delivery. Having pre-delivery EPDS score ≥ 10 (adjusted odds ratio (aOR) 4.61, 95%CI 1.19-17.77, p=0.0266), pre-operative pain score with movement (aOR 1.65, 95%CI 1.03-2.67, p=0.0385), anxiety about upcoming surgery (aOR 1.01, 95%CI 0.99-1.04, p=0.4056), higher pre- operative Hospital Anxiety and Depression Scale (HADS) subscale on anxiety (aOR 1.21, 95%CI 0.99-1.48, p=0.0610), and higher pre-operative central sensitization inventory (CSI) scores (aOR 1.04, 95%CI 0.99-1.10, p=0.0915) were associated with an increased risk of postpartum depression. Anticipated pain medication needs was associated with reduced risk of postpartum depression (aOR 0.59, 95%CI 0.31-1.12, p=0.1041). Internal cross validation and external validation AUC is 0.80 (95%CI 0.69-0.90) and 0.81 (95%CI 0.71-0.91) respectively.

Conclusions The proposed model performed well in our local population. Further refinement may be necessary to test the proposed model in other clinical settings of different social and cultural contexts.