Severity Stratification of Postpartum Depression Using Combined Clinical and Radiological Markers: A Preliminary Exploratory Study

Abstract Purpose: Objective, measurable biomarkers for grading postpartum depression (PPD) severity are lacking. We mapped regional oxygen extraction fraction (OEF) alterations across deep brain nuclei in women with PPD and built a clinical-radiological model to distinguish moderate-to-severe (sPPD) from mild PPD (mPPD).

Methods

We enrolled 38 PPD patients, 38 healthy parturients (PHCs), and 38 non-postpartum healthy females (NPHCs), all of whom completed clinical evaluation, blood tests, and 1.5T MRI. OEF in 16 deep brain nuclei was quantified using the QSM+qBOLD (QQ) algorithm, with FDR-corrected group comparisons. An exploratory multivariate logistic regression model incorporating right globus pallidus OEF (GPrh-OEF), platelet distribution width (PDW), age, and education was used to discriminate sPPD from mPPD, with performance assessed by ROC analysis, 1,000-resample bootstrap validation, and decision curve analysis (DCA).