SAGE: Stability-Aware Graph-Based Ensemble Feature Selection for Explainable Postpartum Depression Risk Prediction

Abstract

Postpartum depression (PPD) poses a major burden on maternal and child health, especially in low- and middle-income countries where prevalence exceeds 19%. Despite advancements in machine learning for PPD prediction, current approaches are limited by opaque global explanations that lack clinical usefulness at the patient level, unstable feature selection, and poor generalization under class imbalance. We propose SAGE, a Stability-Aware Graph-Based Ensemble feature selection system that incorporates both local explainable AI and a genetically optimized artificial neural network (GA-ANN). Using a primary cohort of 766 postpartum women, SAGE combines information-theoretic relevance, PCA-based structure, and graph-based interactions with bootstrap stability weighting to identify robust and non-redundant predictors. The GA-ANN architecture, optimized using a genetic algorithm and enhanced with GAN based oversampling, achieved strong performance with 87.96% accuracy, 86.32% F1 score, and 0.88 AUC using only 16 features, outperforming baseline and other feature selection methods. Psychological and socioeconomic factors such as EPDS score, PHQ-9 score, feelings about motherhood, and abuse history are the main predictors, while demographic factors have less influence. The LIME-based explanations allow instance-based insight into selected features from the graph, enabling personalized risk assessment. The findings make SAGE a scalable, interpretable, and clinical tool for early identification of PPD in health-care limited resources.