2026 ECNP Congress

PS02-2185

Integrative multilevel model for diagnosis and risk stratification of perinatal mental disorders

Boronin Larisa — N. Igor · Nicolae Testemițanu State University of Medicine and Pharmacy- Chișinău- Moldova, Department of Mental Health- Medical Psychology and Psychotherapy- Laboratory of Mental Health- Nicolae Testemițanu State University of Medicine and Pharmacy- Chișinău- Moldova, Chisinau, Moldova

2026 ECNP Congress

Background

Perinatal mental disorders are clinically heterogeneous conditions associated with substantial morbidity and an increased risk of adverse outcomes for both mother and child. These disorders include depressive, anxiety, obsessive-compulsive, and trauma-related conditions, with potential progression to severe psychiatric states. In addition, the perinatal period is characterised by biological, psychological, and social vulnerability, which may contribute to rapid changes in clinical presentation. Conventional diagnostic approaches based on nosological classification do not adequately reflect the dynamic nature of psychopathology or levels of clinical risk. This limitation highlights the need for integrative frameworks that combine symptom-based assessment with evaluation of psychopathological organisation and clinical severity, particularly in complex and rapidly evolving clinical situations. Furthermore, increasing clinical complexity in perinatal psychiatry necessitates approaches capable of capturing both dimensional and transitional aspects of psychopathology.

Aims

To develop and substantiate an integrative multilevel diagnostic model combining psychometric screening and clinical assessment for risk stratification and identification of levels of psychopathological organisation in perinatal mental disorders.

Methods

A theoretical-analytical study based on secondary data analysis was conducted. Diagnostic characteristics of validated psychometric instruments — Edinburgh Postnatal Depression Scale (EPDS), Postpartum Depression Screening Scale (PDSS), Perinatal Anxiety Screening Scale (PASS), City Birth Trauma Scale (City BiTS), PTSD Checklist for DSM-5 (PCL-5), Dimensional Obsessive-Compulsive Scale (DOCS), Perinatal Obsessive-Compulsive Scale (POCS), and Postpartum Bonding Questionnaire (PBQ) — were systematically analysed.

Comparative evaluation of diagnostic parameters across cut-off thresholds was performed to assess variability and clinical applicability. Statistical approaches included correlation analysis, regression modelling, and variance-based comparisons to examine relationships between diagnostic indicators and their threshold-dependent performance.

Results

Diagnostic performance varied across instruments and cut-off values, highlighting the importance of threshold-dependent interpretation. Key thresholds included EPDS ≥10 for depressive symptom screening, PASS ≥21 (≥16 in high-risk populations), and PDSS ≥60, with ≥80 indicating more severe symptomatology.

Analytical comparisons demonstrated variability between instruments and thresholds, without evidence of stable linear relationships between diagnostic indicators. These findings support the concept that psychometric performance is context- and threshold-dependent.

Based on these findings, a multilevel diagnostic model was developed, incorporating sequential stages: screening, psychometric differentiation, clinical verification, severity assessment, and dynamic monitoring. The model enables stratification into low, moderate, high, and critical risk categories and supports clinical decision-making across different levels of care.

Importantly, the model reflects the possibility of transitions between psychopathological registers, as clinical conditions may evolve from neurotic-level symptomatology to psychotic-level disorders in the absence of timely diagnosis and intervention.

Conclusions

The proposed integrative model provides a structured framework linking psychometric screening with clinical evaluation. It improves risk stratification, facilitates early identification of severe conditions, and supports personalised clinical management. The findings emphasise the importance of integrating quantitative and clinical approaches in perinatal mental health assessment and may contribute to improved diagnostic accuracy, early intervention, and better clinical outcomes. This approach may also enhance the sensitivity of early detection strategies and support more precise clinical decision-making in complex perinatal cases. The model may also support enhanced interdisciplinary clinical decision-making in perinatal care.

References

  1. Boronin, L., Belous, M., Jelaga, D., Coșulean, R., Cernov, V., Chihai, J., 2026. Tulburări psihice perinatale: strategii de evaluare și îngrijire integrată. Chișinău: Print-Caro.
  2. American Psychiatric Association, 2013. Diagnostic and statistical manual of mental disorders, fifth ed. American Psychiatric Association Publishing, Washington.
  3. Cox, J.L., Holden, J.M., Sagovsky, R., 1987. Detection of postnatal depression: development of the Edinburgh Postnatal Depression Scale. Br. J. Psychiatry 150, 782–786.
  4. Somerville, S., Dedman, K., Hagan, R., et al., 2014. The Perinatal Anxiety Screening Scale: development and preliminary validation. Arch. Womens Ment. Health 17 (5), 443–454.
  5. Weathers, F.W., Litz, B.T., Keane, T.M., et al., 2013. The PTSD Checklist for DSM-5 (PCL-5). National Center for PTSD.