Vigod et al reported the PMH CAREPLAN score to predict the 1-year risk of a postpartum mental disorder. This can help to identify a woman may benefit from mental health services. The authors are from multiple institutions in Canada.
Patient selection: woman who has just delivered.
Parameters:
(1) prenatal care provider
(2) mental health diagnosis history over lifetime
(3) anti-emetic medication during pregnancy
(4) opioid during pregnancy
(5) psychiatric hospital admissions or emergency department visits
(6) conception type
(7) complications of pregnancy
(8) apprehension (removal) of newborn by child services at birth
(9) region of maternal origin
(10) gestational age at birth
(11) primary maternal language
(12) lactation intention (intention to breastfeed)
(13) maternal age at delivery in years
(14) number of prenatal visits
|
Parameter |
Finding |
Points |
|
prenatal care provider |
obstetrician |
0 |
|
|
family physician |
1 |
|
|
midwife |
3 |
|
|
nurse practitioner |
-5 |
|
|
other |
-2 |
|
mental health history |
none prior |
0 |
|
|
postpartum depression |
8 |
|
|
anxiety |
8 |
|
|
depression |
9 |
|
|
bipolar disorder |
9 |
|
|
other |
7 |
|
anti-emetic medication |
no |
0 |
|
|
yes |
2 |
|
opioid |
no |
0 |
|
|
yes |
2 |
|
psyche hospital or ED visits |
none |
0 |
|
|
lifetime |
5 |
|
conception type |
spontaneous |
2 |
|
|
other |
0 |
|
complications |
none |
0 |
|
|
premature rupture of membranes (PROM) |
2 |
|
|
any postpartum complication |
3 |
|
|
neonatal abstinence |
6 |
|
|
neonatal death in hospital |
10 |
|
apprehension by child services |
no |
0 |
|
|
during delivery admission |
6 |
|
region of maternal origin |
immigrant |
0 |
|
|
non-immigrant |
4 |
|
gestational age at birth |
>= 37 weeks |
0 |
|
|
32-36 weeks |
2 |
|
|
24-31 weeks |
7 |
|
|
20-23 weeks |
8 |
|
primary maternal language |
English |
3 |
|
|
other |
0 |
|
intends to breastfeed |
no |
2 |
|
|
yes |
0 |
|
maternal age at delivery |
>= 39 years |
1 |
|
|
26-38 years |
0 |
|
|
24-25 years |
1 |
|
|
22-23 years |
2 |
|
|
20-21 years |
3 |
|
|
19 years |
4 |
|
|
18 years |
5 |
|
|
<= 17 years |
7 |
|
number of prenatal visits |
0 to 8 |
0 |
|
|
9 to 17 |
5 |
|
|
18 to 26 |
10 |
|
|
>= 27 |
15 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: MAX(0, (total score)), with min value for all of the parameters is -5
• maximum score: MIN(39,(total score)), with max sum for all of parameters is 78
|
Score |
1-year Rate of Common Mental Health Disorders |
|
< 6 |
2% |
|
14 |
5% |
|
20 |
10% |
|
28 |
15% |
|
30 |
20% |
|
33 |
25% |
Performance:
• The C-statistic was 0.69.
Specialty: Psychiatry
