Postpartum Depression: Etiology, Treatment, and Consequences for Maternal Care

Summary & key facts

This review says postpartum depression (PPD) is a common and disabling problem that has been rising in many places. It summarizes known risk factors in social and economic life, childbirth history, lifestyle, and past mental illness. The paper also reviews biological and genetic work (the serotonin transporter gene, SERT, is the most studied), finds the strongest evidence for benefit from antidepressants and psychological therapy, and notes that obstetricians can help by screening with the Edinburgh Postnatal Depression Scale (EPDS).

Key facts:

• A large pooled review found a global PPD prevalence of 17.7% (95% CI: 16.6–18.8%).
• A meta-analysis reported a global postnatal depression prevalence of 17.22% (95% CI: 16.00–18.51).
• Earlier estimates showed PPD prevalence of about 9.5% in high‑income countries, 20.8% in middle‑income regions, and 25.8% in low‑income nations.
• In Romania the reported prevalence was 20.14% (range: 16.39–24.50).
• Studies in India reported postnatal depression rates between 19.8% and 23.3% in some samples.
• Research found that postnatal depression rates were about two times higher during the COVID‑19 pandemic than before the pandemic.
• Strongly associated risk factors include depression or anxiety during pregnancy, a previous history of depression, major life stress, poor partner or marital relations, lack of social support, and low self‑esteem.
• Weaker but present associations were reported for low socioeconomic status, single marital status, and unwanted pregnancy.
• Obstetric risk factors linked to higher PPD risk include having two or more children (multiparity), high‑risk pregnancy or cesarean delivery, perinatal complications, and problems with breastfeeding.
• Biological findings discussed include sensitivity to hormone changes after birth (drops in progesterone and estradiol), altered stress‑axis and immune markers, and changes in serotonin system markers.

Abstract

Postpartum depression (PPD) is a disabling condition that has recently shown an increase in prevalence, becoming an essential public health problem. This study is a qualitative review summarizing the most frequent risk factors associated with PPD, evaluating molecular aspects of PPD and current approaches to detect and prevent PPD. The most prevalent risk factors were detected in the areas of economic and social factors, obstetrical history, lifestyle, and history of mental illness. Research on the genetic basis for PPD has taken place in recent years to identify the genes responsible for establishing targeted therapeutic methods and understanding its pathogenesis. The most frequently studied candidate gene was the serotonin transporter gene (SERT) associated with PPD. Among biological studies, antidepressants and psychological interventions provided the most evidence of successful intervention. The obstetrician can serve an essential role in screening for and treating PPD. Postpartum women with risk factors should be screened using the Edinburgh Postnatal Depression Scale (EPDS), but, at the moment, there are no prevention programs in Europe. In conclusion, data from this review increase concerns among this vulnerable population and can be used to design a screening tool for high-risk pregnant women and create a prevention program.

Topics

Child and Adolescent Psychosocial and Emotional Development Maternal Mental Health During Pregnancy and Postpartum Neuroendocrine regulation and behavior

Categories

Health Sciences Medicine Public Health, Environmental and Occupational Health

Tags

Anxiety Biology Depression (economics) Depressive symptoms Economics Edinburgh Postnatal Depression Scale Environmental health Etiology Genetics Intervention (counseling) Macroeconomics Medicine Mental health Mental illness Nursing Population Postpartum depression Pregnancy Psychiatry Psychological intervention Public health