Postpartum
depression (PPD):
a
depressive episode
with a
significant burden
of disease
and urgency for treatment1,2

Examine the various risk factors and significant impact
PPD can have on mothers and their babies

PPD definition & prevalence
Burden of disease
Risk factors
Screening & diagnosis
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PPD definition & prevalence Burden of disease Risk factors Screening & diagnosis

PPD definition & prevalence

PPD is characterized as a major depressive episode* with onset of symptoms during pregnancy or within the first 4 weeks to 12 months postpartum1,3

However, expert opinion and guideline definitions of PPD differ between sources.1,3

*According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, a major depressive episode is a primary component of major depressive disorder (MDD) but differs from MDD in that MDD cannot be better explained by a psychotic disorder and there has never been a manic or hypomanic episode.1

Image of PPD infographic, click link to download PDF
PPD infographic

Explore a quick reference guide that uncovers the reality for patients with PPD.

Download PPD infographic
Did you know?

PPD is a type of major depressive episode and is not the same as the “baby blues.”1,4

The “baby blues” describes mild mood changes and feelings of worry, unhappiness, and exhaustion in the first 2 weeks after having a baby.4

If these feelings last longer than 2 weeks, it may be PPD.4

PPD may be more prevalent than perceived due to underreporting and underscreening

Nearly 1 in 5 women who have delivered are estimated to have experienced PPD worldwide5†

Despite being a common postpartum mental health disorder,5 PPD is often underdiagnosed and undertreated.6,7

PPD may be underreported due to minimization by patients and societal stigma.8,9

In the US, ~1 in 8 women with a recent live birth reported symptoms of PPD in 2018.7‡

The likelihood of a depressive episode in the postpartum period can be twice as high as during other periods of a woman's life.5

†Based on a systematic review and meta-analysis completed in 2021 that included 173,342 women from 80 countries with a diagnosis of PPD. The US subgroup included 66 studies of 34,380 participants.5

‡Based on 2018 data analyzed by the CDC from the Pregnancy Risk Assessment Monitoring System that described PPD symptoms among women who recently delivered a baby and assessed if health care providers asked about depression during prenatal and postpartum health care visits.7
Did you know?

Anxiety symptoms may also be more common or more severe for women with PPD.10

Woman looking down at crying baby
Woman looking down at crying baby

Dr. Barrett, MD, discusses the underdiagnosis of PPD

Tune in to hear more about the challenges in managing PPD and the importance of screening and diagnosis. 

The burden of PPD may impact a mother in many different ways

Mental health conditions were the leading cause of pregnancy-related deaths according to 2017–2019 data from the Centers for Disease Control and Prevention.11

Mothers that experienced a major depressive episode (MDE) in the postpartum period were ~3x as likely to experience a suicide attempt, compared to mothers who did not experience an MDE in the postpartum period.12§

§According to a retrospective analysis of data from 1,439 patients in psychiatric Mother-Baby Units in France and Belgium from 2001 to 2010.12

PPD is associated with6

  • Maternal difficulties bonding and nurturing newborn
  • Low birth weight
  • Lactation failure
  • Unplanned weaning
  • Toxic stress

PPD may also impair a mother's overall function, which can include their ability to:

  • Care for their baby 10
  • Care for their own physical needs 10
  • Perform household chores 13,14

Burden of disease | Impact on children

The disease impact could extend to children of mothers with PPD

Short- and long-term impacts on the physical and mental development of children of mothers with PPD symptoms have the potential to last all the way into adulthood.6,15,16

Children of mothers with PPD and/or anxiety are more likely to have impaired development across multiple domains, including17||:

Social/emotional

Cognitive

Adaptability

||Based on a systematic review and meta-analysis of 308 studies analyzed from January 1, 2019 to March 15, 2020. The social-emotional domain included 11 subdomains: social-emotional composite, externalizing behavior, internalizing behavior, peer problems, prosocial behavior, attachment, dysregulation, and temperament, including positive emotionality, negative emotionality, orienting/regulation, and difficulty. The cognitive domain included 8 subdomains: cognitive composite, verbal IQ, inhibition, performance IQ, memory, working memory, visual spatial, and academic achievement. The adaptability domain included 1 subdomain: adaptability composite. The cognitive domain includes two other domains, language and motor. The language domain included 3 subdomains: language composite, expressive language, and receptive language. The motor domain included 3 subdomains: motor composite, gross motor, and fine motor.17

Risk factors

Risk factors of PPD include18:

Social

  • Lack of social support
  • Domestic violence
  • History of sexual abuse

Obstetric

  • Risky pregnancy
  • Meconium passage
  • Umbilical cord prolapse
  • Preterm or low birth infant
  • Low hemoglobin

Psychological

  • Depression/anxiety
  • Premenstrual syndrome
  • Negative attitude toward baby

Lifestyle

  • Smoking during pregnancy
  • Poor eating habits
  • Impaired sleep cycle
  • Reduced physical activity/exercise
Did you know?

History of depression is associated with a >20x higher risk for PPD compared to those without a history of depression.19

Screening & diagnosis

Time is of the essence when it comes to screening for and treating PPD

PPD is often unrecognized and undertreated—nearly 70% of PPD cases may have gone undiagnosed according to a 2016 PPD literature review.6

Elevated depressive symptoms can persist beyond the postpartum period and last at least 3 years after giving birth.20

Patients who experience PPD are at risk of future episodes of major depressive disorder (MDD).21

~6% of women with PPD received adequate treatment approaches, according to a 2016 PPD literature review.6

See why early improvement matters for MDD

Did you know?

The American College of Obstetricians and Gynecologists recommends screening for PPD and anxiety at least once during the perinatal period, and once during the comprehensive postpartum visit.3

Baby lying on bed and woman looking out window crying
Baby lying on bed and woman looking out window crying
Image of EPDS screener, click link to download PDF
Edinburgh Postnatal Depression Scale (EPDS)

Get a refresher on a screener tool used at the comprehensive postpartum visit to help identify women who may have PPD.

Download EPDS screener
For patients with MDD, how does the burden differ?

You’ve seen the reality for patients with PPD, now uncover the burden for patients with MDD.

Explore the differences
Looking beyond monoamines in depression

The science behind depression is expanding. See what other neurotransmitters may play a role in depression.

See the science

References: 1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, (Fifth Edition, Text Revised). 2022. 2. Batt MM, Duffy KA, Novick AM, Metcalf CA, Epperson CN. Is postpartum depression different from depression occurring outside of the perinatal period? A review of the evidence. Focus (Am Psychiatr Publ). 2020;18(2):106-119. 3. ACOG Committee Opinion No. 757: Screening for perinatal depression. Obstet Gynecol. 2018;132(6):e208-212. 4. National Institute of Mental Health. Perinatal Depression. Accessed January 3, 2023. https://www.nimh.nih.gov/sites/default/files/documents/health/publications/perinatal-depression/20-MH-8116-PerinatalDepression.pdf. 5. Wang Z, Liu J, Shuai H, et al. Mapping global prevalence of depression among postpartum women. Transl Psychiatry. 2021;11(1):5431. 6. Cox EQ, Sowa NA, Meltzer-Brody SE, et al. The perinatal depression treatment cascade: baby steps toward improving outcomes. J Clin Psychiatry. 2016;77(9):1189-1200. 7. Bauman BL, Ko JY, Cox S, et al. Vital signs: postpartum depressive symptoms and provider discussions about perinatal depression - United States, 2018. MMWR Morb Mortal Wkly Rep. 2020;69(19):575-581. 8. Iturralde E, Hsiao CA, Nkemere L, et al. Engagement in perinatal depression treatment: a qualitative study of barriers across and within racial/ethnic groups. BMC Pregnancy Childbirth. 2021;21(1):512. 9. Henshaw EJ, Durkin KM, Snell RJ. First-time parents' shared representation of postpartum depressive symptoms: a qualitative analysis. Soc Sci Med. 2016;160:102-110.​ 10. Thurgood S, Avery DM, Williamson L. Postpartum depression (PPD). Am J Clin Med. 2009;6(2):17-22. 11. Trost S, Beauregard J, Chandra G, et al. Pregnancy-related deaths: data from maternal mortality review committees in 36 US states, 2017-2019. Maternal Mortality Review Information App; 2022. 12. Gressier F, Guillard V, Cazas O, Falissard B, Glangeaud-Freudenthal NM, Sutter-Dallay AL. Risk factors for suicide attempt in pregnancy and the post-partum period in women with serious mental illnesses. J Psychiatr Res. 2017;84:284-291. 13. Posmontier B. Functional status outcomes in mothers with and without postpartum depression. J Midwifery & Women’s Health. 2008;53(4): 310-318. 14. Logsdon MC, Wisner K, Hanusa BH, et al. Role functioning and symptom remission in women with postpartum depression after antidepressant treatment. Arch Psychiatr Nurs. 2003;17(6):276-283. 15. Pearson RM, Evans J, Kounali D, et al. Maternal depression during pregnancy and the postnatal period: risks and possible mechanisms for offspring depression at age 18 years. JAMA Psychiatry. 2013;70(12):1312-1319. 16. Netsi E, Pearson RM, Murray L, et al. Association of persistent and severe postnatal depression with child outcomes. JAMA Psychiatry. 2018;75(3):247-253. 17. Rogers A, Obst S, Teague SJ, et al. Association Between Maternal Perinatal Depression and Anxiety and Child and Adolescent Development: A Meta-analysis. JAMA Pediatr. 2020;174(11):1082-1092. 18. Ghaedrahmati M, Kazemi A, Kheirabadi G, et al. Postpartum depression risk factors: A narrative review. J Educ Health Promot. 2017;6:60. 19. Silverman ME, Reichenberg A, Savitz DA, et al. The risk factors for postpartum depression. Depress Anxiety. 2017;34(2):178-187. 20. Putnick DL, Sundaram R, Bell EM, et al. Trajectories of Maternal Postpartum Depressive Symptoms. Pediatrics. 2020;146(5). 21. Mughal S, Azhar Y, Siddiqui W. Postpartum depression. StatPearls. Treasure Island (FL): StatPearls Publishing; October 7, 2022. https://www.ncbi.nlm.nih.gov/books/NBK519070/.

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