Factors Associated with the Development of Postnatal Depression After Cesarean Delivery: A Prospective Study

Pre-operative association factors (pain and psychological vulnerability) could significantly contribute to post-Cesarean pain; however, limited information is available on the development of postnatal depression (PND). We aimed to investigate the development of PND and its association with pain vulnerability and psychological vulnerability factors.

Women undergoing Cesarean delivery under spinal anesthesia were given pre-operative questionnaires, psychological and pain assessments including pain on local anesthetic injection during spinal anesthesia and mechanical temporal summation. Post-operative assessments were administered at 6 to 10 weeks post-Cesarean delivery via follow-up survey to assess post-Cesarean psychological and pain outcomes.

PND occurred in 21.1% (43 of 205) of patients who underwent elective Cesarean delivery. An increased pre-operative pain score with movement (Odds ratio (OR) 1.65, 95% CI 1.12-2.44, p = 0.0110), anxiety about upcoming surgery (OR 1.02, 95% CI 1.00-1.04, p = 0.0429), higher pre-operative Hospital Anxiety and Depression Scale (HADS) subscale on anxiety (OR 1.25, 95% CI 1.07-1.45, p = 0.0041) and higher pre-operative central sensitization inventory (CSI) scores (OR 1.05, 95% CI 1.01-1.09, p = 0.0156) were independently associated with an increased risk of PND. Anticipated pain medication needs were associated with reduced risk of PND (OR 0.48, 95% CI 0.29-0.79, p = 0.0038) (Receiver operating characteristic (ROC) = 0.8177).

Higher pre-operative anxiety, pain score, central sensitization and lower anticipated pain medication needs were associated with increased risks of PND. Further work using larger sample size will be needed to validate the model in predicting PND development after Cesarean delivery.