Screening for individuals with postpartum depression by an attenuated and delayed niacin skin flushing response: a case control study.

BACKGROUND

Postpartum depression (PPD) affects maternal mental health extensively and is challenged by the lack of objective diagnostic methods. This study aimed to explore the characteristics of niacin skin flush response, a diagnostic marker for depression, in individuals with PPD and to determine its clinical potential as an adjunctive screening marker.

METHODS

A total of 1417 parturients was recruited in this study. Edinburgh Postnatal Depression Scale was used to screen for depression with a cut-off score ≥ 13. The Patient Health Questionnaire-9 scale was used to test the consistency of scale screening. The Chi-square test was used to compare the screening results of the two scales, and the reliability and validity of the two scales were discussed. Mann Whitney U test was used to analyze the differences in niacin-flushing between PPD and healthy controls (HC), and a ten-fold cross-validation with logistic regression was used to verify the potential of niacin-flushing to distinguish between PPD and HC. A screening model for women with PPD was established by bivariate truncation method.

RESULTS

The results of the two depression screening scales were 12.85% inconsistent, indicating the nonobjectivity of the scale screening. Compared with the healthy women, women with PPD exhibited significantly attenuated and delayed niacin-induced flushing response. An innovative and user-friendly postpartum depression screening model was established according to the features, by which we could identify women with PPD from healthy women with a sensitivity of 53.09% (95% CI: 42.22% - 63.95%) and a specificity of 73.28% (95% CI: 70.90% - 75.65%).

CONCLUSIONS

This study identified the characteristics of impaired niacin response in women with PPD, and established a potential screening standard for PPD, which is highly objective and operable. The niacin-blunted subgroup of PPD may imply a common biological basis, which provokes new thoughts in elucidating the pathological mechanisms of postpartum depression.