essays on postpartum depression

Postpartum depression: Causes, symptoms, risk factors, and treatment options

Women and Girls

What is postpartum depression and anxiety?

It’s common for women to experience the “baby blues”—feeling stressed, sad, anxious, lonely, tired or weepy—following their baby’s birth. But some women, up to 1 in 7, experience a much more serious mood disorder—postpartum depression (PPD). (Postpartum psychosis, a condition that may involve psychotic symptoms like delusions or hallucinations, is a different disorder and is very rare.) Unlike the baby blues, PPD doesn’t go away on its own. It can appear days or even months after delivering a baby; it can last for many weeks or months if left untreated. PPD can make it hard for you to get through the day, and it can affect your ability to take care of your baby, or yourself. PPD can affect any woman—those with easy pregnancies or problem pregnancies, first-time mothers and mothers with one or more children, women who are married and women who are not, and regardless of income, age, race or ethnicity, culture, or education.

What are the symptoms of PPD?

The warning signs are different for everyone but may include:

A loss of pleasure or interest in things you used to enjoy, including sex

Eating much more, or much less, than you usually do

Anxiety—all or most of the time—or panic attacks

Racing, scary thoughts

Feeling guilty or worthless; blaming yourself

Excessive irritability, anger, or agitation; mood swings

Sadness, crying uncontrollably for very long periods of time

Fear of not being a good mother

Fear of being left alone with the baby

Inability to sleep, sleeping too much, difficulty falling or staying asleep

Disinterest in the baby, family, and friends

Difficulty concentrating, remembering details, or making decisions

Thoughts of hurting yourself or the baby (see below for numbers to call to get immediate help).

If these warning signs or symptoms last longer than 2 weeks, you may need to get help. Whether your symptoms are mild or severe, recovery is possible with proper treatment.

What are the risk factors for PPD?

A change in hormone levels after childbirth

Previous experience of depression or anxiety

Family history of depression or mental illness

Stress involved in caring for a newborn and managing new life changes

Having a challenging baby who cries more than usual, is hard to comfort, or whose sleep and hunger needs are irregular and hard to predict

Having a baby with special needs (premature birth, medical complications, illness)

First-time motherhood, very young motherhood, or older motherhood

Other emotional stressors, such as the death of a loved one or family problems

Financial or employment problems

Isolation and lack of social support

What can I do?

Don’t face PPD alone. To find a psychologist or other licensed mental health provider near you, ask your OB/GYN, pediatrician, midwife, internist, or other primary health care provider for a referral. APA can also help you find a local psychologist: Call 1-800-964-2000, or visit the APA Psychologist Locator .

Talk openly about your feelings with your partner, other mothers, friends, and relatives.

Join a support group for mothers—ask your health care provider for suggestions if you can’t find one.

Find a relative or close friend who can help you take care of the baby.

Get as much sleep or rest as you can even if you have to ask for more help with the baby—if you can’t rest even when you want to, tell your primary health care provider.

As soon as your doctor or other primary health care provider says it’s okay, take walks, or participate in another form of exercise.

Try not to worry about unimportant tasks. Be realistic about what you can do while taking care of a new baby.

Cut down on less important responsibilities.

Remember that postpartum depression is not your fault—it is a real, but treatable, psychological disorder. If you are having thoughts of hurting yourself or your baby, take action now: Put the baby in a safe place, like a crib. Call a friend or family member for help if you need to. Then, call a suicide hotline (free and staffed all day, every day):

IMAlive 1-800-SUICIDE (1-800-784-2433)

988 Suicide and Crisis Lifeline Dial 988 (Formerly known as The National Suicide Prevention Lifeline 1-800-273-TALK)

Other versions

Download this Brochure (PDF, 476KB)

En Español (PDF, 419KB)

En Français (PDF, 240KB)

中文 (PDF, 513KB)

All translations of the English Postpartum Depression brochure were partially funded by a grant from the American Psychological Foundation.

Crisis hotlines and resources

Postpartum Health Alliance

Postpartum Support International

American Foundation for Suicide Prevention

Health Resources and Services Administration

National Women’s Health Center

Psychology topics: Women and girls
Psychology topics: Depression

I hid my postpartum depression ... until a friend got me to find help

I lied to the first person who asked me if I had postpartum depression.

Four days after giving birth, I was sitting on a chair in the pediatrician’s office, holding my crying newborn, who was there for her first visit. I was barely able to stand. My body was sore, bleeding and tired. My thoughts were sloppy and my speech was delayed. The nurse greeted us and handed me an iPad without explanation. I looked down and saw a postpartum depression survey. The questions felt like tricks.

Have I been anxious or worried for no good reason? Of course I have. I’m trying to keep my newborn alive and I have no idea what I’m doing.

Have I felt sad or miserable? Yes, but I have felt other things too.

Have I been able to laugh and see the funny side of things? I thought back to the night before when my baby refused to latch onto my breast and wouldn’t eat for eight hours. My husband and I paced around the apartment wondering if we should bring her to the hospital. No, I wasn’t able to see the funny side of things.

Have I blamed myself unnecessarily when things went wrong? How could I not? When my baby cried, it felt entirely like my fault.

I looked up at my baby. I started to get paranoid that if I answered these questions honestly, they’d take her away from me. I changed all of my answers so I could come across like a new mom who was coping well. I fooled everyone. The pediatrician commented on how well I was doing. Her praise encouraged me to continue to lie, and I became very good at doing that in the weeks that followed.

Postpartum depression grew on me, silent and invisible. It started with frequent mood swings, random tears and moments of anger toward my husband. It evolved fast. I found myself refusing to answer calls or text messages from friends or family. I obsessed over how I felt like the worst mom and questioned whether my baby even loved me. I couldn’t shake the guilt that I had over decisions I made in labor or how I couldn’t breastfeed because my nipples were in too much pain. I was depressed, anxious and beginning to show OCD-like symptoms around allowing anyone to care for the baby unless I was right there beside them.

My husband and I didn’t know much about postpartum depression before it consumed me. He witnessed what I was going through but assumed it was normal. I don’t blame him for that. I was pretending it was normal too. I feared if I told him differently, he’d turn on me and take the baby away. I know now he’d never do something like that, but back then my thoughts haunted me without glimmers of clarity.

1. Find a Therapist Who Specializes in Postpartum Depression

The thought of finding a therapist seemed daunting. My friend took the first step for me. She went on Psychology Today, searched for therapists with a postpartum speciality who took my health insurance plan, and sent me a list of five. She wrote me a script that I could copy and paste to send to each person. Within a week, I had an appointment scheduled.

Here’s the script that my friend wrote for me (feel free to borrow it):

My name is Jen Glantz. I am reaching out because I came across your profile on Psychology Today and saw that you specialize in postpartum depression. I’m looking to work with someone who can provide a safe and supportive environment for me to explore and process what I’m feeling as a new mom.

Could we please schedule a time to have a brief phone call to discuss your approach to therapy and see if working together feels right.

I look forward to hearing from you soon.

2. Speak With Other New Moms

I felt comfortable talking to my friend because she shared her own experience with postpartum depression and made me feel less alone. While I had ghosted most of my other friends and family, I started to recognize that I didn’t want to feel lonely, I just wanted to be surrounded by people who understood me. My friend shared three postpartum support groups that she had gone to in the past. One was virtual and the other two were local. I started going once a week to an in-person group.

I didn’t speak much when I was there, but I was able to meet other new moms. I enjoyed the group because it made me feel seen. This helped me stop lying about what I was experiencing, first to the people in the group, and later to friends and family.

3. Ask for Help

Eventually, my friends and family grew worried. When I wouldn’t respond to them, they would reach out to my husband, whom I begged to help me hide what I was going through. He would tell them that I was busy and overwhelmed. He told them we’d reach out soon to make plans. But when I was around three months postpartum, with the help of therapy and support groups, I decided to let people know what I was experiencing and ask them for help.

I brainstormed a few actionable ways they could help. I asked a cousin I am close to if she could come over on Wednesdays to sit with the baby while I privately spoke to my therapist in the other room. I asked a friend who lived nearby if she would be willing to go on outdoor walks with me once a week, because I needed the motivation to get outside.

Asking for help isn’t easy, especially when you are struggling. Rachel Goldberg , a licensed therapist who specializes in postpartum depression, shared a script that you can use to tell with loved ones that you are going through a tough time as a new parent and could use their help.

I wanted to reach out because I’ve realized I may have seemed a bit different or more withdrawn lately. I’ve been finding it challenging to adjust to all the new changes of being a new mom, but I feel ready to open up more about it with you. I believe opening myself to more support could be beneficial. Are you available to (chat on the phone, come over, go for a walk with me... etc.) sometime soon?

How to Help a Friend With PPD

If you feel like someone you know might be experiencing postpartum depression, Goldberg recommended the script below to use as a way of reaching out to them.

I’ve been thinking about you a lot lately and wanted to check in. I’ve noticed that you haven’t been your usual self and might be going through a tough time. I want you to know that I care about you deeply, and I’m here to support you in any way I can. If you ever feel like talking about what’s on your mind or need help finding the right support, please let me know.

Even though I have a lot of friends and family members, I was able to fool them. I was able to sneak past health care professionals who didn’t make me feel safe enough to really open up about my struggles. I am grateful that I had one person in my life familiar with postpartum depression symptoms who could understand what I was going through. Without her, I don’t know when I would have found the strength to reach out for help.

Jen Glantz is the founder of Bridesmaid for Hire, an author and a new mom living in Brooklyn. Learn more here .

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Sadness and Support: a Short History of Postpartum Depression

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Sadness and Support: A Short History of Postpartum Depression

Robert Sparks Essay Contest May 3, 2013

A famous case:

“Once upon a time, there was a little girl who dreamed of being a mommy. She wanted, more than anything, to have a child and knew her dream would come true one day. She would sit for hours thinking up names to call her baby….And then one day, finally, she became pregnant. She was thrilled beyond belief. She had a wonderful pregnancy and a perfect baby girl. At long last, her dream of being a mommy had come true. But instead of being relieved and happy, all she could do was cry.”

Brooke Shields famously compared her tears following the birth of her daughter to the rain taking down the itsy-bitsy spider in the well-known children’s song. The above quote is from the opening page to Shields’ widely read memoir, Down Came the Rain, published in 2005.

Shields’ book gave a public and famous face to a disease that women had suffered silently throughout all of history. In it, Shields shares in intimate detail her struggles following the birth of her daughter. She was helpless, sad, and scared. She lost all motivation to parent. She did not acknowledge her depression. For some time, she resisted professional help and medication and even contemplated suicide. And when she came out whole on the other side, after successful treatment with antidepressant medications and psychotherapy , she wanted to prevent others from suffering in silence.1

Now, nearly a decade later, thanks to Shields and a host of other celebrities, bloggers, researchers and political advocates, postpartum depression (PPD) has become a household term. Today, when women go to a physician for prenatal care , they see posters in the doctor’s office explaining what PPD is and what they should do if they develop depressive symptoms after childbirth . As part of routine childbirth classes and when leaving the hospital after childbirth, women are given pamphlets about PPD and business cards for counselors and psychiatrists, should they need them. And pregnant women are

routinely screened for PPD at postpartum obstetrics follow-ups—and even by pediatricians during infant checkups. Such widespread awareness and acceptance of PPD did not always abound, however.

Recent research indicates that nearly 70-80% of women suffer from some depressive symptoms within the first two weeks following delivery. These depressive symptoms are now widely recognized as manifesting in various ways with varying degrees of severity. Tearfulness and mood lability seen soon after birth in many women has become known as the postpartum or “baby blues.” The postpartum blues are considered a “normal” reaction to giving birth. However, some women experience true major depressive episodes in the weeks and months following birth that are more persistent, manifesting as loss of pleasure, interest, sleep, and self-worth. It is these episodes that are referred to as PPD, estimated to affect 10-13% of women during the postpartum period . Finally, beyond the postpartum blues and major depressive episodes, about 1 or 2 in 1000 women develop cognitive disturbances, bizarre behavior or hallucinations , and a severe condition known as postpartum psychosis . 2

Depression following childbirth has long carried a social stigma. Many people think that a woman should be happy following the birth of a child—and when she is not, she is often looked upon unkindly.

Women have long tried to hide signs of depression, sometimes with dire consequences when their depressive symptoms turn into thoughts of harming themselves or their babies. A well-publicized example is that of Melanie Stokes, who killed herself in

Chicago in 2001 after suffering postpartum mental illness.3 Recent legislation to support

PPD research and advocacy now bears her name.

Moreover, medical professionals have not long been supportive of treatment for depression following childbirth. The psychiatric community did not officially recognize depression in the postpartum period until the fourth edition of its Diagnostic and Statistical

Manual, published in 1994. Even now, the DSM IV identifies depression with a postpartum onset as being only depression that appears within four weeks after delivery of a baby.

However, many experts argue that PPD may develop anytime within the first year following delivery, and clinicians are encouraged to screen women for periods longer than just those four weeks following the birth of their children.4

Controversies and speculation about depressive symptoms following childbirth have existed since the earliest medical literature. Hippocrates made the first known reference to PPD in the fourth century B.C. and his hypotheses became dogma that survived for over a thousand years. He proposed that lochial discharge—the fluid that comes from the uterus after birth—if suppressed, could flow to the head and result in agitation, delirium and attacks of mania . He also thought that blood collecting at the breasts of a woman could indicate onset of madness.5 Another early reference to postpartum mental symptoms comes from Trotula, a 13th century female physician, who believed that postpartum mental disturbances were due to increased moisture in the body following childbirth. She wrote “If the womb is too moist, the brain is filled with water, and the moisture running over the eyes, compels them to involuntarily shed tears.”6

Even then, down came the rain.

Observations of postpartum mental disturbances continued throughout history.

During the Middle Ages, women who exhibited melancholy during or after childbirth were thought to be witches or victims of witchcraft, as any other stigmatized individual might

have been. By the 16th century, descriptions existed of a “disturbance of the maternal instinct” following childbirth, and most reports were focused on mothers who killed their children. Known as “melancholic filicide,” these deaths led physicians to increase study of postpartum mental disorders. One well-known 16th century physician, Castello Branco, described a case of postpartum melancholy as such: “The beautiful wife of Carcinator who always enjoyed the best of health, was attacked after childbirth by melancholy, and remained insane for a month, but recovered with treatment.” Though Branco does not describe what type of treatment he used for the wealthy woman, reports of experimental treatments began to surface over the following centuries.7

An early case:

A 25-year-old woman gives birth to a child at home. She is accompanied in the birth by a local midwife, and the midwife comes back to check on her periodically following the birth of her child. The woman begins to feel very sad and overwhelmed in the weeks following the birth of her child. She ceases to cook and barely feeds her baby. Her neighbors become worried that the baby may die and call for the local physician to come see this woman in her home. The physician is unsure of why the woman is unhappy, even in light of having a new healthy baby, but he has seen other women act like this in past. He tells the woman to take lukewarm baths and he gives her a medication that he says will calm her mind.

In the mid-19th century, Jean-Etienne Esquirol became one of the first physicians to provide detailed case reports of postpartum psychiatric illnesses. He reported 92 cases of postpartum delirium and melancholy and suggested that the numbers of women suffering from postpartum mental disturbances was likely higher than the number of cases he observed in mental hospitals. He thought that mild cases were likely cared for at home and never reached his hospital. Esquirol suggested treatment that included careful nursing, tepid baths and purgatives—a common treatment for many medical ailments at the time.8

Esquirol, like most doctors of the 19th century, believed that two categories of postpartum illness could be defined: puerperal, which was said to occur within 6 weeks of childbirth, and lactational, meaning that it occurred greater than 6 weeks following delivery. These categories survived for decades despite the lack of any true scientific evidence for the division.

Around the same time, an American psychiatrist, MacDonald, objected to the rigid classification of puerperal mental illness based on time of onset and proposed classifying diagnoses based on acuteness of onset of symptoms. Symptoms observed included decreased strength and spirit, restlessness, sleeplessness, and irritability. His treatments also included tepid baths—specifically given between 94 and 98°F—as well as “large doses of opium” to calm the mind 9 The use of opium should not be too surprising—as with

Esquirol’s purgatives, opium was given for all variety of ailments at the time.

In 1858, Louis-Victor Marcé published the first formal paper devoted entirely to puerperal mental illness, his Treatise On Insanity In Pregnant, Postpartum, And Lactating

Women. He wrote of 310 cases of pregnant and postpartum women that he had personally observed and became the first to systematically address categorization of their disorders.

In his results, he reported that 9% of women developed depression during pregnancy, 58% in the puerperal period, and 33% in the lactational period. Marcé noted no major features distinguishing the psychoses of pregnancy from those in women in the non-pregnant state.

However, he believed that postpartum cases of depression had many features that distinguished them from other mental illnesses and proposed that this should indeed be classified as a separate diagnosis. His main observation was that while most PPD symptoms could be found in other types of mental disturbances, the syndromes—that is, the

particular combinations of symptoms—were distinct. In line with Hippocrates and Trotula before him, Marcé hypothesized that postpartum psychological symptoms occurred in relationship with the profound organic and functional changes occurring in the female reproductive system following childbirth.10

Marcé is still remembered today through the Marcé Society, a group of physicians and researchers who unite to study PPD throughout the world. His work has had a significant impact on history of PPD—however, not always as might be imagined.

Historically, Marcé’s research was often used as early evidence that PPD was not a separate entity from other forms of depression, based on a misinterpretation of his statements that depression in pregnancy was not a separate entity.

During the 19th century, treatments for PPD changed in line with the medical ideas of the era. Many at the time suggested bleeding as a way to reduce inflammation and eliminate excess fluid in the body. Similarly, many recommended opium to calm the mind.

Restraints and separation from the woman’s infant were also popular. These were immortalized in Charlotte Perkins Gillman’s story The Yellow Wallpaper. Gillman tells a story about a young woman suffering from strange thoughts following the birth of her child. The woman’s husband places the woman in a room at a summer home, away from her child, to help her improve, but rather than get better, she proceeds to become even more delusional.11

In the early 20th century, three main lines of thought emerged regarding the description of mental disturbance and depression following childbirth. These three theories were eloquently summarized and discussed by Dr. James Hamilton, a preeminent

psychiatrist and founder of the Marcé Society, in his 1962 book, Postpartum Psychiatric

The first theory, proposed by Strecker and Ebaugh in 1926, suggested that depression following childbirth had no actual relationship to the pregnancy, delivery, or postpartum changes and was indistinct from other psychiatric illness. Strecker and Ebaugh believed that all cases of postpartum mental illness could be fit into other standard categories of psychiatric illness— dementia praecox, manic-depression, and delirium. They called on physician groups to eliminate “ postpartum psychosis ” from the psychiatric terminology, and the American Psychiatric Association and American Medical Association did indeed remove it from their diagnostic manuals based on these and other recommendations.

In his book, written several decades later, Hamilton pointed out perceived flaws in their research. For example, he noted that a large majority of cases categorized as manic- depressive had noticeable clouding of the sensorium – a symptom usually not seen in affective disease. Despite perceived flaws, however, the Strecker and Ebaugh study stood up for decades and even still contributes to controversy in perinatal psychiatric literature to this day.

A second theory, proposed by Zilboorg in 1928, used the psychogenic etiologies popularized by Freud and others at the turn of that century, to explain PPD. Zilboorg attributed PPD to pre-pregnancy frigid personalities. He and others suggested that there might be a potential relationship to suppressed homosexuality, unresolved Oedipal longings, or anal-regressive resultant-father identification. This theory was further developed by Franks in 1934, proposed that strong, unresolved incestuous drives, frigidity,

attachment to the father, and schizoid characteristics (among other hypotheses) might be the root of PPD. While such beliefs have not survived into modern day understandings of

PPD, these psychologists did publish the first observations of personal history or family history of depression in women with postpartum symptoms—a legacy that may be found in current research supporting that women who have previously experienced depression, or who have a family history of mental illness, are more likely to develop PPD than women with no historical factors.12

Finally, the third theory of the time harkened back to the work of Marcé, as well as

Hippocrates and Trotula before him, suggesting that physiologic changes in women’s bodies surrounding the birth of the child may uniquely lead to postpartum psychiatric changes distinct from other illnesses. Kilpatrick and Tiebout in 1926 suggested that PPD might be due to “an unknown toxic process.” They cited cases in which women had concurrent thyroid enlargement, menstrual difficulties, and excessive hair growth with

PPD, and hypothesized that the processes were likely linked. Additionally, Kanosh and

Hope in 1937 reported on asymptomatic periods following birth, and believed that psychiatric symptoms must be related to some chemical or hormonal change that occurred after a few days. They also suggested that PPD might possibly be related to lactation as they noted some cases of women who developed depressive symptoms only after weaning of their infant.13

Following the Second World War in the mid-20th century, many psychiatrists began studying milder forms of postpartum psychiatric diseases. It was noted that women often did not seek care for postpartum illness due to fears of being placed in a psychiatric hospital and separated from their husbands and children. As described in the example of

Gillman’s story The Yellow Wallpaper, it had once been common to separate women suffering from depressive symptoms from their infants . In the late 1940s, however, psychiatric wards in Britain and Australia began successfully incorporating mother-and- baby units where mothers suffering from PPD could receive care, while remaining close to their infants.14

A modern case:

A 29-year-old female presents for her six-week postpartum check-up. She is accompanied by her healthy six-week old son. When asked how she is today, she tears up and responds, “Ok … I guess.” She has filled out a mood-screening questionnaire that shows that she feels exhausted, has decreased interest in things, and has not been finding enjoyment in her normal activities. When questioned further, she reports feeling very down and teary during the last few weeks. She has lost interest in reading and knitting and finds it hard to even feed her child. She has had decreased appetite, increased anxiety , and cannot sleep even when her baby is sleeping. She’s been feeling like this for several weeks and thinks it may be getting worse. Her physician discusses treatment with anti-depressant medications, though she acknowledges risks of such drugs while breastfeeding . She suggests the woman might see a psychiatrist and a counselor for help with her current symptoms.

In the later 20th century, many of the ideas and treatments that are still prevalent today began to develop, often building on the ideas of earlier physicians while incorporating new scientific research techniques to refine our understanding of PPD. In

1968, Brice Pitt described “atypical” depression in the postpartum. His was one of the first modern studies to draw attention to “less severe” depressions than postpartum psychosis.

His study was designed in response to the work of community health visitors who went to check on new mothers in their homes after discharge from the hospital following childbirth. These nurses reported to him that many women dealt with varying degrees of depression following birth, but most did not seek treatment. Pitt’s large cohort study was

the first community-based study of depression in the postpartum and he found that approximately 10.8% of women in the cohort suffered PPD. He called the depression

“atypical” because the symptom profile was somewhat different than non-postpartum depression.15

In addition to the Western observations of PPD, many studies have shown that postpartum blues and postpartum psychosis occurs in fairly uniform ways across cultures.

PPD varies depending on cultural demands placed on women postpartum, but most cultures have forms of PPD and various beliefs about its causes. In Uganda, for example, there is a recognized puerperal mental illness called “Amakiro,” which is believed to be caused by promiscuity of the mother during pregnancy. Symptoms of Amakiro include restlessness, pallor, and mental confusion , as well as the notion that the mother wants to eat her baby. In Nigeria, there is a postpartum mental illness known as “Abisiwin,” which is believed to be caused by too much heat in the body. 16

Cross-cultural research has also pointed out that Western cultures often place high demands on women to re-integrate quickly into society following childbirth, while other cultures may keep woman at rest or in seclusion while elder women care for the new baby.

Some have hypothesized that this social requirement for women to return to work and other stressful environments quickly following the birth of a child may contribute to higher rates of PPD in Western cultures.17

Over the past 40 years, there has continued to be much debate in psychiatry surrounding PPD. Questions have arisen such as “Is pregnancy protective against depression or a risk factor for depression?” “Should postpartum blues, depression and psychosis be viewed as distinct entities or a continuum of symptoms?” Literature from the

1980s and 90s continued to examine these questions. The idea first proposed many years ago by Marcé, preceded well before him by Hippocrates and Trotula, and developed by others in the early 20th century—that PPD is likely related to hormonal changes in the perinatal period—has become a leading theory in PPD research during recent years.

Studies have shown that artificially inducing the hormonal changes associated with the postpartum period significantly increases risk of developing depression. Other studies have identified additional important risk factors for PPD, such as stressful life events, family history of mood disorders, and personal history of depression.18

Until the early 1990s, most psychiatric organizations still espoused the idea that there were not enough unique features of PPD to warrant a separate disease categorization in psychiatric diagnostic manuals. The DSM-IV, released in 1994, incorporated

“postpartum onset” as a modifier to major depression, bipolar illness, and other psychiatric diagnoses; this specifier is used when such disorders appear within four weeks following the birth of a child. However, much current literature challenges the “postpartum” definition of 4 weeks following birth and suggests that PPD may still appear even months after giving birth.19

In addition to at least some formal recognition of PPD as a unique entity, treatment for depression in general also greatly improved in the 1990s, and the medications developed have also been successful in improving symptoms of PPD. Antidepressant medications came into widespread use for PPD in the late 1990s, and just as they became the first-line treatment for major depressive disorder, SSRIs are also now the first-line of medication treatment for PPD. Few controlled studies exist regarding the use of these

medications following pregnancy, but what does exist indicates benefit from the treatment.

However, concerns regarding infant drug exposure through breastmilk still abound.20

Perhaps the greatest change in thinking surrounding PPD has been the shift to include more focus on screening, as well as the surge of advocacy surrounding the diagnosis. In the last decade, there has been widely increased focus on prevention of PPD via support groups and therapy. Screening at postpartum obstetrics visits and initial newborn visits to a pediatrician are now increasingly commonplace. And with the stories of Brooke Shields and other famous women in the mainstream media and less formal outlets on the Internet, there has been much wider acceptance in society of women who are not perfectly happy following the birth of a child. Increased discussion of the condition has led to more support, and the beginnings of a reduction in stigma, for women who suffer from PPD. Recent advances in this area include the Melanie Blocker-Stokes Act, which provides government funding for research and advocacy for PPD in the United States, legislation in New Jersey mandating screening for PPD, as well as a surge in popularity of blogs and support groups related to PPD, such as Katherine Stone’s “Postpartum Progress,” and the Postpartum Support International group.21

PPD is a common and treatable condition. However, it has been subject to controversy and stigma throughout much of history, leading to misclassification and lack of access to treatment for many patients. While many barriers, including stigma, still exist that limit this access for perinatal women,22 further research and advocacy in this area will continue to improve treatment and access to care for women suffering from depressive symptoms following childbirth.

1 Shields B. Down Came the Rain: My Journey Through Postpartum Depression. New York: Hyperion, 2006.

2 Flynn HA. Epidemiology and Phenomenology of Postpartum Mood Disorders. Psychiatric Annals 2005. 35(7): 544-551.

3 Elton C. Postpartum Depression: Do All Moms Need Screening? Time. 20 Jul 2009. Available via (Accessed 2 May 2013)

4 Battle CL. Zlotnick C. Prevention of Postpartum Depression. Jul 2005. Psychiatric Annals. 35(7): 590-598.

5 Hamilton JA. Chapter 12, History. In Postpartum Psychiatric Problems. St Louis: Mosby Harwin, 1962, p126.

6 Trotula of Salerno, The Diseases of Women. A translation of Passionibus Mulierum Curandorum by Elizabeth Mason-Hohl, MD. Los Angeles: The Ward Ritchie Press;1940.

7 Brockinton I. A Historical Perspective on the Psychiatry of Motherhood. In Perinatal Stress , Mood and Anxiety Disorders: From Bench to Bedside. Basel, Switzerland: Karger Publishers, 2005.

8 Hamilton, 1962, p126-7.

9 Hamiton, 1962, p 127.

10 Hamilton, 1962, p. 127-30.

11 Gillman CP. The Yellow Wallpaper, first published 1899 by Small & Maynard, Boston, MA.

12 O’Hara MW. Postpartum Depression Causes and Consequences. New York: Springer- Verlag, 1995.

13 Hamilton, 1962, p.132-136.

14 Brockington, 2005.

15 Pitt B. Atypical Depression Following Childbirth. Brit J Psychiatr 1968; 114: 1325-1335.

16 Cox JL. Postnatal Depression. Edinburgh: Churchill Livingstone Publishers, 1986.

17 Cox, 1986.

18 Wisner KL, Parry BL, Piontek CM. Postpartum Depression. N Engl J Med 2002; 347(3): 194-199.

19 Kendell RE, Chalmers JC, Platz C. Eipdemiology of puerperal psychoses. Br J Psychiatry 1987; 150:662-73.

20 Miller LJ, ed. Postpartum Mood Disorders. Washington, DC: American Psychiatric Press Inc., 1999.

21 Information about these initiatives can be found via: (NJ Screening law), (Postpartum Progress Blog) and (Postpartum Support International)

22 Kopelman RC, Moel J, Mertens C, Stuart S, Arndt S, O’Hara M. Barriers to Care for Antenatal Depression . Psychiatric Services. Apr 2008. 59(4): 429-432.

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Postpartum Depression: Treatment and Therapy Essay

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Introduction

Postpartum depression.

Although for many people the birth of a child is an exciting part of life, for some it may cause adverse health outcomes. One of them is postpartum depression that can be characterized by mood swings, sleep deprivation, and anxiety. This paper discusses a patient that presented in the clinic with these symptoms. It outlines the possible treatment and therapy methods, as well as the implications of the condition.

A 28-year-old patient presented in the office three weeks after giving birth to her first son with the symptoms of postpartum depression. The woman was a single mother; she did not have a strong support system as her former partner refused to help her and her family lived in a different state. She noted that she was sleep-deprived, she felt apathetic, sad, experienced anxiety, and had a decreased appetite.

The patient reported that she was diagnosed with depression seven years ago but underwent treatment and had not had the symptoms for a long time. The woman noted that her mother also had signs of a mental disorder but never sought professional help. The patient cried while talking to me; her emotional state was poor. In addition, the woman admitted that she had thought of harming her newborn son because she felt that she was tired of taking care of him.

The typical signs of postpartum depression include the presence of sleep disorder, fatigue, crying, anxiety, changes in appetite, and feelings of inadequacy (Tharpe, Farley, & Jordan, 2017). The patient has these symptoms, which allowed for establishing the diagnosis. Drug therapy included the prescription of tricyclic antidepressants, as they do not pose risks to infants during breastfeeding (Anxiety and Depression Association of America, 2018). Additional therapies included adequate nutrition with the exclusion of caffeine and herbal remedies, such as 2 cups of lemon balm tea daily (Tharpe et al., 2017).

Moreover, I advised the woman to participate in support groups’ meetings and have a scheduled time for personal care, hobbies, and favorite activities, as well as sleep. In addition, I asked the patient to try to have some time away from her child as it could improve her mental state as well. As for follow-up care measures, I suggested that the woman could document her thoughts and feelings and update me on the changes in her condition by visiting my office in two weeks. Moreover, I invited the patient to participate in an educational session on the aspects of postpartum depression.

The primary implication of the woman’s condition is that it is vital to educate individuals on its symptoms and assure them that this experience is common. Moreover, it is necessary to continue establishing support groups and psychotherapy sessions aimed to eliminate this issue. Postpartum depression may affect not only this woman but her entire family unit as the individuals close to the patient can also start experiencing emotional distress and other related symptoms. In the case of my patient, the condition may affect her relationships with her child, potentially causing a poor emotional bond and behavioral problems in the infant.

Postpartum depression is a severe condition that may affect a patient’s life significantly. It can cause individuals to feel anxious, experience mood swings and changes in appetite, and have thoughts of harming their newborn children. The management strategy for this illness can include drug therapy along with alternative remedies. It is vital to establish support groups and educational training for people having postpartum depression to decrease its incidence.

Anxiety and Depression Association of America. (2018). Postpartum depression . Web.

Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th ed.). Burlington, MA: Jones & Bartlett Publishers.

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Mom Talk: Will I Ever Love Her?

Written by Loren Kleinman

Postpartum depression is different for every person who experiences it. In the case of New Jersey-based writer and mom Loren Kleinman , her depression lead to a psychiatric emergency when she was just a month postpartum with her daughter, Lily (now 4). Even if postpartum depression is not something you’ve dealt with, her deeply personal story is something we think every mother can relate to.

Life before Lily was a hazy blend of ambitions, dreams, and snapshots of what motherhood would look like: quiet nights with lullabies and nursery rhymes, afternoons filled with smiles, and the unmatched joy of watching my baby girl take her first steps. In reality, it was painful. She never slept, and each time I tended to her, my skin pulled at the site of my C-section. My hands were still swollen from my pregnancy-induced carpel tunnel syndrome and whenever I breastfed her, they became numb and tingly.

I wished her away several times a day, even Googling: How to put your newborn up for adoption? Despite these feelings, I was physically drawn to her . An enigma that I couldn’t fathom.

After Lily, I felt out of place in my own skin. I constantly worried whether I could get through the first year of our lives together. I couldn’t decide whether this tiny person who was tugged out of me was here to torment me or fill me with love.

One month postpartum, I shared my anxieties with my OB. She attributed my struggles to the baby blues and handed me a pamphlet detailing the signs of Postpartum Mood and Anxiety Disorder. Dismissing my concerns, she sent me home, expecting improvement over time. Yet, as the physical pains began to subside, the emotional abyss of postpartum depression gripped me tighter.

The whispers of depression became a constant companion, taunting me with insecurities. “You’re an unfit mother,” it hissed, “You’ll never love her, and she’ll never love you.” My only escape was to end my life.

Two months postpartum, on October 30, 2019, after a failed suicide attempt and at the desperate pleadings of my husband Joe, I voluntarily admitted myself to the Hackensack Medical Center Psychiatric Unit.

The night before, I took a handful of Klonipin and Tylenol like the Internet said, but nothing happened. Instead, I wobbled to Lily’s bassinet and watched her sleep. I wished I could crawl in beside her, close my eyes, and never wake up. I wanted so badly to die. I wanted to let her have the life she deserved—a life without me.

“I don’t want to go up there,” I begged Joe as I relinquished my wedding band, cell phone, and clothes to the attending nurse. “But I can’t do this anymore. I can’t be a mom.”

“You’re doing the right thing,” he said. With his dimpled smile, I knew he was trying his best to keep hope alive.

I hung my head below my shoulders. “I’m not the person you married.”

“I have to get back to the baby,” he said. “We’re all going to be ok.”

He took my bag of valuables from the nurse. “Get some rest.”

By the time I got a room in the unit, I’d already been in the ER by myself for 12 hours. It was early morning, 3am-ish. My psyche-mate was already asleep. I felt alone and humiliated that it had come to this.

My first full day at the psychiatric unit marked two months since Lily’s birth, coinciding with Halloween. Her first holiday and her two-month birthday slipped away without me. I missed her, but I didn’t understand why. A hole seemed to deepen inside me the longer I was away from Lil.

At the same time, I disliked her: the feedings, the inconsolable crying. But then I remembered the quiet mornings when we’d hold each other’s gaze. I never wanted and not wanted anyone so much.

Everything felt inverted. Even my name was reversed on my hospital bracelet: Kleinman Loren.

Joe visited often, bringing books and pictures of Lily—the only outsider things allowed in the unit. Babies weren’t.

As we occupied our small space in the vastness of the activities room, the nurses’ watchful eyes bore into us. In a psych ward, privacy is a luxury. Even in our rooms, the bathrooms were door-less, just a long curtain separated my roommate and me.

“I’m missing it all,” I whispered, surprised by my own admission. “All I want is to leave this place.”

“Focus on getting better, not on leaving,” he whispered back. “We’ll still be here.”

I resented Joe and the hospital. A murky fish tank illuminated the room with its day-glow radiance. Fluorescent light made everything shine. The floors, the shower, the people. It rendered the day sterile. I imagined Joe and I freely leaving amid a round of applause in the rec room. The doors would open, and we’d be on our way to our baby girl.

The following day, Joe accompanied me for a family visit with my psychiatrist, Dr. Hirsch, and my social worker.

Dr. Hirsch proposed discharging me right away, a notion Joe rebuffed. Despite reassurances from Dr. Hirsch about my stable condition, Joe questioned how much time he’d genuinely spent with me.

Joe’s insistence on my prolonged stay infuriated me, triggering my ire to the point where I demanded a divorce. His eyes welled up at my outburst.

Joe posed a direct question: “What keeps you from wanting to end it all now?”

“I miss my family.”

While he said it was a good start, it couldn’t be the sole reason. I hoped he’d realize the anguish of being separated from our family was gnawing at me, that my desire for life stemmed from my longing for my old life.

But that didn’t suffice for him. My emotions were still all over the place. One day I wanted to go home; the next, a huge burden of responsibility lifted from my shoulders knowing I was here.

I agreed to stay two more days.

When Joe left, he promised to return after dinner. But soon into my meal, a note arrived. He was too exhausted to drive.

The nurses asserted that I would leave well-rested and prepared to be a good mom. This perplexed me since Joe said I’m already a good mom by agreeing to stay at the hospital.

In group therapy, I began to slowly unravel the complexities of my depression. How the deep and consuming love for my baby coexisted with my seemingly bottomless anxiety and fear. How the dull ache of exhaustion and sleep deprivation made every feeling of wanting to escape ten times more intense.

When Joe came to visit again his eyes were red and his smiles less frequent. His jovial nature seemed to be overshadowed by the weight of our situation. I found myself yearning to comfort him, to reassure him that I was on the path to recovery. But I couldn’t. The guilt of putting our family through this was still raw.

When the day of my discharge came, I felt a rush of emotions. The walls of the hospital, initially so cold and sterile, were now something I was scared to leave.

The house was as I’d left it: quiet and loud. The ticking of the baby swing next to a messy pile of baby clothes and distant hum of a full dishwasher played on repeat. Time can be in freefall, but it was as if it were waiting for my return.

When I held Lily, her tiny form in my arms and soft breath against my chest brought a rip tide of emotion—powerful, relentless, and utterly overwhelming. A painful concoction of joy, relief, love, and fear. As I studied her tiny fingers wrapped around mine, I was struck by the fragility of the moment.

I started crying. I cried because I was sad. I cried because I was happy. I cried because I was scared. I cried because I was tired. I cried because I wanted to be alone and because I didn’t want to be alone.

As I sat there with Lily in my arms, Joe massaged my shoulders. “It’s okay,” he whispered.

Through therapy, medication, and time, my bond with Lily grew. Despite recognizing that my depression wasn’t something I inflicted upon her, I felt the need to apologize. I felt the weight of the missed bath times, feedings, diaper changes, and playtimes. Moreover, I felt remorse for considering her a mistake in my worst moments and proposing she and Joe move while I sorted myself out.

There were days, even after my hospitalization, when I found myself questioning my worth, my strength as a mother. I was learning, however, slowly, and painfully, that my struggle wasn’t a testament to my failure, but to my humanity. My postpartum depression wasn’t a sign of weakness, but a manifestation of an illness as real as a broken bone.

Before my hospitalization, I’d often questioned whether I loved Lily.

I once asked my sister, a mother of two: How do you know when you love your child?

“You’ll feel like your heart is about to explode,” she said.

I feared I’d never know what that was like.

Almost four years later, it’s like I’d always been at home with Joe and Lily—like I’d never been sick.

But it did happen, and when the conversation came up recently with Joe about having another baby, I quickly said, “No.” Even with the most well-intentioned postpartum plan , I might not survive next time.

I’ve made peace with postpartum depression, but it didn’t teach me about personal strength and resilience. It taught me about powerlessness. I couldn’t recognize this depression on my own. I needed Joe to help me recognize it.

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Postpartum Depression Can Be Dangerous. Here’s How to Recognize It and Seek Treatment.

The sooner this serious mental health issue is diagnosed, the sooner it can be treated. Knowing your risk factors is the first step.

Credit... Tallulah Fontaine

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By Tara Haelle

Published April 17, 2020 Updated July 19, 2021

This guide was originally published on June 10, 2019 in NYT Parenting.

I have a history of depression, so in the weeks following the births of both of my children, my husband and mother were on high alert for any signs of postpartum depression. Not to be confused with the “baby blues” — or the feelings of worry, unhappiness and fatigue that up to 80 percent of women experience in the first weeks after giving birth — postpartum depression is a serious mental health issue that affects an estimated 10 to 20 percent of new mothers. Its symptoms include frequent crying, trouble sleeping and feeling sad, hopeless, overwhelmed, guilty, angry or disconnected from others, including your new baby.

Unlike the “baby blues,” which typically clear up on their own after a few days, postpartum depression can last for anywhere from a few months to several years.

I didn’t have postpartum depression with my first child, but because I closely monitored my symptoms with my second, I knew that I needed help a few weeks after his birth. Experts agree that recognizing the signs of postpartum depression early is key to effective treatment.

For this guide, I read several scientific studies and spoke with two ob-gyns, a pediatrician and a reproductive psychiatrist to help you understand postpartum depression and how to treat it.

Understand what postpartum depression is — and isn’t.
Recognize the symptoms.
Learn what increases your risk of postpartum depression.
Know you’re not alone.
Contact a medical professional for treatment.
Seek social support and keep yourself physically healthy.
When to Worry

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Home — Essay Samples — Nursing & Health — Neurology & Nervous System Diseases — Postpartum Depression

Essay Examples on Postpartum Depression

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58 Postpartum Depression Essay Topics

🏆 best essay topics on postpartum depression, 👍 good postpartum depression research topics & essay examples, 🎓 most interesting postpartum depression research titles, 💡 simple postpartum depression essay ideas.

Postpartum Depression in Women and Men
Postpartum Depression Screening Program Evaluation
Diagnostic Assessment. Postpartum Psychosis
Physiological Psychology. Postpartum Depression
Postpartum Depression: Evidence-Based Practice
Postpartum Depression: Evidence-Based Care Outcomes
Postpartum Depression: Diagnosis and Treatment
Postpartum Depression In First-time Mothers The most common mental health problem associated with childbirth remains postpartum depression, which can affect both sexes, and negatively influences the newborn child.
The Diagnosis and Treatment of Postpartum Depression Postpartum depression has many explanations, but the usual way of referring to this disease is linked to psychological problems.
The Concept of Postpartum Depression Postpartum depression is a common condition involving psychological, emotional, social, and physical changes that many new mothers experience immediately after giving birth.
What Is Postpartum Depression? Causes, Symptoms, and Treatment The prevalence of postpartum depression is quite high as one in seven new American mothers develops this health issue.
Baby Blues: What We Know About Postpartum Depression The term Postpartum Depression describes a wide variety of physical and emotional adjustments experienced by a significant number of new mothers.
Predictors of Postpartum Depression The phenomenon of postpartum depression affects the quality of women’s lives, as well as their self-esteem and relationships with their child.
Predictors of Postpartum Depression: Who Is at Risk? The article “Predictors of Postpartum Depression” by Katon, Russo, and Gavin focuses on the identification of risk factors related to postnatal depression.
Postpartum Depression: Methods for the Prevention Postpartum depression is a pressing clinical problem that affects new mothers, infants, and other family members. The prevalence of postpartum depression ranges between 13 and 19 percent.
Postpartum Depression, Prevention and Treatment Postpartum depression is a common psychiatric condition in women of the childbearing age. They are most likely to develop the disease within a year after childbirth.
Women’s Health: Predictors of Postpartum Depression The article written by Katon, Russo, and Gavin is focused on women’s health. It discusses predictors of postpartum depression (PPD), including sociodemographic and clinic risk factors.
Postpartum Depression as Serious Mental Health Problem The research study aimed to evaluate the effectiveness of a two-step behavioral and educational intervention on the symptoms of postpartum depression in young mothers.
Postpartum Depression: Uncovering the Myths and Facts
Baby Blues and Postpartum Depression: Mood Disorders and Pregnancy
Helping Mothers Navigate Postpartum Depression
Non-Drug Ways to Help Treat Postpartum Depression
Healing From Postpartum Depression: A Holistic Approach to Recovery
Treatment of Postpartum Depression: Clinical, Psychological and Pharmacological Options
The Neuroendocrinological Aspects of Pregnancy and Postpartum Depression
Depression and Anxiety Among Postpartum and Adoptive Mothers
Postpartum Depression in Single Mothers Who Abandoned Their Children
The Impact of Postpartum Depression on the Early Mother-Infant Relationship
Managing Postpartum Depression: Strategies for Coping and Seeking Help
Postpartum Depression: Etiology, Treatment, and Consequences for Maternal Care
Short-Term Oestrogen as a Strategy to Prevent Postpartum Depression in High-Risk Women
Through the Eyes of Single Mothers: Postpartum Depression and Perceptions of Risk
Redefining Maternal Care at Work: A Focus on Postpartum Depression
Understand the Difference Between Baby Blues and Postpartum Depression
The Hidden Struggle: Understanding Postpartum Depression
Postpartum Depression: Early Diagnosis and Management
Understanding the Online Social Support Dynamics for Postpartum Depression
Association Between Social Support and Postpartum Depression
Postpartum Depression: Self-Care Is Critical for the Mom and Her Baby
Overcoming Postpartum Depression: A Journey of Healing and Hope
Effects of Gonadal Steroids in Women With a History of Postpartum Depression
Engaging and Treating Low-Income Mothers for Postpartum Depression
Dads and Postpartum Depression: Breaking the Silence
Exploring Predictors and Prevalence of Postpartum Depression Among Mothers
The Impact of Sleep Deprivation on Postpartum Depression
Postpartum Depression and How to Talk to Your Doctor About It
Hormonal Changes in the Postpartum and Implications for Postpartum Depression
Prenatal Exposure to Bisphenols and Phthalates and Postpartum Depression
A Blended Cognitive-Behavioral Intervention for the Treatment of Postpartum Depression
After Baby Is Born: Postpartum Depression and Relationships
Psychosocial and Psychological Interventions for Treating Postpartum Depression
Treating Postpartum Depression With Complementary or Alternative Medicine
Postpartum Depression and Anxiety: Doctor Advice How Family and Friends Can Support the Mother
Warning Signs of Baby Blues and Postpartum Depression
Postpartum Depression and the Potential of Allopregnanolone
Common Misconceptions About Postpartum Depression
Breastfeeding and Postpartum Depression: Further Insights Into a Complicated Relationship
Psychotherapy’s Efficacy in the Treatment of Postpartum Depression

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Patient Care & Health Information
Diseases & Conditions
Postpartum depression

The birth of a baby can start a variety of powerful emotions, from excitement and joy to fear and anxiety. But it can also result in something you might not expect — depression.

Most new moms experience postpartum "baby blues" after childbirth, which commonly include mood swings, crying spells, anxiety and difficulty sleeping. Baby blues usually begin within the first 2 to 3 days after delivery and may last for up to two weeks.

But some new moms experience a more severe, long-lasting form of depression known as postpartum depression. Sometimes it's called peripartum depression because it can start during pregnancy and continue after childbirth. Rarely, an extreme mood disorder called postpartum psychosis also may develop after childbirth.

Postpartum depression is not a character flaw or a weakness. Sometimes it's simply a complication of giving birth. If you have postpartum depression, prompt treatment can help you manage your symptoms and help you bond with your baby.

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Symptoms of depression after childbirth vary, and they can range from mild to severe.

Baby blues symptoms

Symptoms of baby blues — which last only a few days to a week or two after your baby is born — may include:

Mood swings
Irritability
Feeling overwhelmed
Reduced concentration
Appetite problems
Trouble sleeping

Postpartum depression symptoms

Postpartum depression may be mistaken for baby blues at first — but the symptoms are more intense and last longer. These may eventually interfere with your ability to care for your baby and handle other daily tasks. Symptoms usually develop within the first few weeks after giving birth. But they may begin earlier — during pregnancy — or later — up to a year after birth.

Postpartum depression symptoms may include:

Depressed mood or severe mood swings
Crying too much
Difficulty bonding with your baby
Withdrawing from family and friends
Loss of appetite or eating much more than usual
Inability to sleep, called insomnia, or sleeping too much
Overwhelming tiredness or loss of energy
Less interest and pleasure in activities you used to enjoy
Intense irritability and anger
Fear that you're not a good mother
Hopelessness
Feelings of worthlessness, shame, guilt or inadequacy
Reduced ability to think clearly, concentrate or make decisions
Restlessness
Severe anxiety and panic attacks
Thoughts of harming yourself or your baby
Recurring thoughts of death or suicide

Untreated, postpartum depression may last for many months or longer.

Postpartum psychosis

With postpartum psychosis — a rare condition that usually develops within the first week after delivery — the symptoms are severe. Symptoms may include:

Feeling confused and lost
Having obsessive thoughts about your baby
Hallucinating and having delusions
Having sleep problems
Having too much energy and feeling upset
Feeling paranoid
Making attempts to harm yourself or your baby

Postpartum psychosis may lead to life-threatening thoughts or behaviors and requires immediate treatment.

Postpartum depression in the other parent

Studies show that new fathers can experience postpartum depression, too. They may feel sad, tired, overwhelmed, anxious, or have changes in their usual eating and sleeping patterns. These are the same symptoms that mothers with postpartum depression experience.

Fathers who are young, have a history of depression, experience relationship problems or are struggling financially are most at risk of postpartum depression. Postpartum depression in fathers — sometimes called paternal postpartum depression — can have the same negative effect on partner relationships and child development as postpartum depression in mothers can.

If you're a partner of a new mother and are having symptoms of depression or anxiety during your partner's pregnancy or after your child's birth, talk to your health care provider. Similar treatments and supports provided to mothers with postpartum depression can help treat postpartum depression in the other parent.

When to see a doctor

If you're feeling depressed after your baby's birth, you may be reluctant or embarrassed to admit it. But if you experience any symptoms of postpartum baby blues or postpartum depression, call your primary health care provider or your obstetrician or gynecologist and schedule an appointment. If you have symptoms that suggest you may have postpartum psychosis, get help immediately.

It's important to call your provider as soon as possible if the symptoms of depression have any of these features:

Don't fade after two weeks.
Are getting worse.
Make it hard for you to care for your baby.
Make it hard to complete everyday tasks.
Include thoughts of harming yourself or your baby.

If you have suicidal thoughts

If at any point you have thoughts of harming yourself or your baby, immediately seek help from your partner or loved ones in taking care of your baby. Call 911 or your local emergency assistance number to get help.

Also consider these options if you're having suicidal thoughts:

Seek help from a health care provider.
Call a mental health provider.
Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline , available 24 hours a day, seven days a week. Or use the Lifeline Chat . Services are free and confidential. The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).
Reach out to a close friend or loved one.
Contact a minister, spiritual leader or someone else in your faith community.

Helping a friend or loved one

People with depression may not recognize or admit that they're depressed. They may not be aware of signs and symptoms of depression. If you suspect that a friend or loved one has postpartum depression or is developing postpartum psychosis, help them seek medical attention immediately. Don't wait and hope for improvement.

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There is no single cause of postpartum depression, but genetics, physical changes and emotional issues may play a role.

Genetics. Studies show that having a family history of postpartum depression — especially if it was major — increases the risk of experiencing postpartum depression.
Physical changes. After childbirth, a dramatic drop in the hormones estrogen and progesterone in your body may contribute to postpartum depression. Other hormones produced by your thyroid gland also may drop sharply — which can leave you feeling tired, sluggish and depressed.
Emotional issues. When you're sleep deprived and overwhelmed, you may have trouble handling even minor problems. You may be anxious about your ability to care for a newborn. You may feel less attractive, struggle with your sense of identity or feel that you've lost control over your life. Any of these issues can contribute to postpartum depression.

Risk factors

Any new mom can experience postpartum depression and it can develop after the birth of any child, not just the first. However, your risk increases if:

You have a history of depression, either during pregnancy or at other times.
You have bipolar disorder.
You had postpartum depression after a previous pregnancy.
You have family members who've had depression or other mood disorders.
You've experienced stressful events during the past year, such as pregnancy complications, illness or job loss.
Your baby has health problems or other special needs.
You have twins, triplets or other multiple births.
You have difficulty breastfeeding.
You're having problems in your relationship with your spouse or partner.
You have a weak support system.
You have financial problems.
The pregnancy was unplanned or unwanted.

Complications

Left untreated, postpartum depression can interfere with mother-child bonding and cause family problems.

For mothers. Untreated postpartum depression can last for months or longer, sometimes becoming an ongoing depressive disorder. Mothers may stop breastfeeding, have problems bonding with and caring for their infants, and be at increased risk of suicide. Even when treated, postpartum depression increases a woman's risk of future episodes of major depression.
For the other parent. Postpartum depression can have a ripple effect, causing emotional strain for everyone close to a new baby. When a new mother is depressed, the risk of depression in the baby's other parent may also increase. And these other parents may already have an increased risk of depression, whether or not their partner is affected.
For children. Children of mothers who have untreated postpartum depression are more likely to have emotional and behavioral problems, such as sleeping and eating difficulties, crying too much, and delays in language development.

If you have a history of depression — especially postpartum depression — tell your health care provider if you're planning on becoming pregnant or as soon as you find out you're pregnant.

During pregnancy, your provider can monitor you closely for symptoms of depression. You may complete a depression-screening questionnaire during your pregnancy and after delivery. Sometimes mild depression can be managed with support groups, counseling or other therapies. In other cases, antidepressants may be recommended — even during pregnancy.
After your baby is born, your provider may recommend an early postpartum checkup to screen for symptoms of postpartum depression. The earlier it's found, the earlier treatment can begin. If you have a history of postpartum depression, your provider may recommend antidepressant treatment or talk therapy immediately after delivery. Most antidepressants are safe to take while breastfeeding.
Depressive disorders. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision DSM-5-TR. American Psychiatric Association; 2022. https://dsm.psychiatryonline.org. Accessed May 9, 2022.
Postpartum depression. Office on Women's Health. https://www.womenshealth.gov/mental-health/mental-health-conditions/postpartum-depression. Accessed May 5, 2022.
Depression among women. Centers for Disease Control and Prevention. https://www.cdc.gov/reproductivehealth/depression/index.htm. Accessed May 5, 2022.
What is peripartum depression (formerly postpartum)? American Psychiatric Association. https://www.psychiatry.org/patients-families/postpartum-depression/what-is-postpartum-depression. Accessed Nov. 18, 2022.
Viguera A. Postpartum unipolar depression: Epidemiology, clinical features, assessment, and diagnosis. https://www.uptodate.com/contents/search. Accessed Nov. 18, 2022.
Viguera A. Mild to moderate postpartum unipolar major depression: Treatment. https://www.uptodate.com/contents/search. Accessed May 6, 2022.
Viguera A. Severe postpartum unipolar major depression: Choosing treatment. https://www.uptodate.com/contents/search. Accessed May 6, 2022.
Faden J, et al. Intravenous brexanolone for postpartum depression: What it is, how well does it work, and will it be used? Therapeutic Advances in Psychopharmacology. 2020; doi:10.1177/2045125320968658.
FAQs. Postpartum depression. American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/postpartum-depression. Accessed May 6, 2022.
Suicide prevention. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/suicide-prevention. Accessed May 6, 2022.
Postpartum depression. Merck Manual Professional Version. https://www.merckmanuals.com/professional/gynecology-and-obstetrics/postpartum-care-and-associated-disorders/postpartum-depression#. Accessed May 6, 2022.
AskMayoExpert. Depression in pregnancy and postpartum. Mayo Clinic; 2022.
American Academy of Pediatrics. Postpartum care of the mother. In: Guidelines for Perinatal Care. 8th ed. American Academy of Pediatrics; American College of Obstetricians and Gynecologists; 2017.
Kumar SV, et al. Promoting postpartum mental health in fathers: Recommendations for nurse practitioners. American Journal of Men's Health. 2018; doi:10.1177/1557988317744712.
Scarff JR. Postpartum depression in men. Innovations in Clinical Neuroscience. 2019;16:11.
Bergink V, et al. Postpartum psychosis: Madness, mania, and melancholia in motherhood. American Journal of Psychiatry. 2016; doi:10.1176/appi.ajp.2016.16040454.
Yogman M, et al. Fathers' roles in the care and development of their children: The role of pediatricians. Pediatrics. 2016; doi:10.1542/peds.2016-1128.
FDA approves first treatment for post-partum depression. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-post-partum-depression. Accessed May 6, 2022.
Deligiannidis KM, et al. Effect of zuranolone vs placebo in postpartum depression: A randomized clinical trial. JAMA Psychiatry. 2021; doi:10.1001/jamapsychiatry.2021.1559.
Betcher KM (expert opinion). Mayo Clinic. May 10, 2022.
988 Suicide & Crisis Lifeline. https://988lifeline.org/. Accessed Nov. 18, 2022.

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Postpartum depression.

Karen Carlson ; Saba Mughal ; Yusra Azhar ; Waquar Siddiqui .

Affiliations

Last Update: August 12, 2024 .

Continuing Education Activity

Postpartum depression (PPD) is a prevalent and potentially severe mood disorder that affects approximately 1 in 7 women within the first year after childbirth. PPD stems from a combination of hormonal changes, genetic predisposition, and environmental factors, yet up to 50% of cases remain undiagnosed due to the stigma surrounding the condition and patients' reluctance to disclose symptoms. Unlike the transient "baby blues," PPD is more severe, often manifesting as persistent sadness, low self-esteem, sleep disturbances, anxiety, and difficulties bonding with the baby. Effective recognition and management of PPD are essential for optimizing the health outcomes of the parent and infant.

This activity describes the evaluation of postpartum depression and how to differentiate it from other mood disorders that may occur in the postpartum period. Participants learn to identify the various etiologies and clinical presentations of PPD, as well as the underlying biochemical and psychological pathways. This activity also emphasizes the importance of routine screening using tools like the Edinburgh Postnatal Depression Scale and also highlights the roles of psychotherapy, support groups, and safe medications in treatment. Collaborating with an interprofessional healthcare team is highlighted, helping participants enhance their ability to implement best practices for treating and preventing PPD, ultimately improving patient outcomes. Regulatory guidelines are also covered to ensure a standardized approach to PPD care.

Identify the specific signs and symptoms of postpartum depression, including persistent sadness, low self-esteem, sleep disturbances, anxiety, loss of appetite, and difficulty bonding with the baby.
Differentiate postpartum depression from other mood disorders that may occur in the postpartum period, such as the "baby blues," postpartum psychosis, and generalized anxiety disorder, by understanding their unique clinical presentations and durations.
Apply the latest evidence-based guidelines and best practices for managing postpartum depression, staying updated with current research and clinical recommendations to optimize patient outcomes.
Apply interprofessional team strategies to improve care coordination and outcomes for patients with postpartum depression.
Introduction

Postpartum depression (PPD) is a mood disorder that affects individuals within 1 year after childbirth. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), postpartum depression is now included in the term perinatal depression. [1] A major depressive episode that begins during pregnancy or within 4 weeks after delivery is classified as peripartum depression. This term encompasses both prenatal and postpartum depression. The DSM-5 does not recognize PPD as a separate entity. Instead, PPD is included within the broader diagnosis of peripartum depression. [2] Unlike the "baby blues," which typically resolve within a few weeks, PPD is more severe and can last for months if untreated.

Depression symptoms, including persistent sadness, lack of interest, low self-esteem, sleep disturbances, loss of appetite, anxiety, irritability with a hostile attitude towards infants, self-blame, and feelings of humiliation characterize PPD. People with PPD may also experience changes in sleeping and eating patterns, difficulty bonding with their baby, and feelings of hopelessness or worthlessness. [3] Recognizing and addressing PPD is crucial for the health and well-being of the patient and their baby. If left untreated, PPD can interfere with the ability to care for the child and may contribute to long-term developmental issues in the child (eg, emotional and behavioral problems). PPD can also strain family relationships and increase the risk of suicide. [4]

Screening for PPD should be a routine part of postpartum care, utilizing tools such as the Edinburgh Postnatal Depression Scale (EPDS) to identify those at risk. Treatment typically involves a combination of psychotherapy, support groups, and medication, including antidepressants, which can safely be used during lactation. Up to 50% of PPD cases remain undiagnosed due to patient reluctance to disclose symptoms, partly because of the stigma around PPD, which includes fears of abandonment and lack of support upon disclosure. [5] Raising awareness about PPD, reducing stigma, and ensuring access to mental health resources are essential steps in supporting new parents and promoting healthy family dynamics.

The exact cause of PPD is not fully understood, but potential underlying etiologies contributing to the development of this condition include hormonal changes, genetic predisposition, and psychosocial stressors. The rapid drop in estrogen and progesterone levels after delivery, coupled with the stress and sleep deprivation that often accompany caring for a newborn, can trigger depressive episodes in susceptible people.

In a meta-analysis of 33 studies, gestational diabetes, having boy infants, a history of depression, and epidural anesthesia use were noted as risk factors. However, further research is needed to assess the true significance of these reported risk factors, especially the sex of the infant and the use of epidural anesthesia. [3] Besides hormonal, other changes in many metabolic pathways may be associated with the development of postpartum depression, including alterations in energy metabolism, the purine and amino acid cycles, steroid and neurotransmitter metabolism, and exposure to xenobiotics. [6]

Postpartum Depression Risk Factors

Factors associated with a high risk of developing postpartum depression include:

Psychological : A personal history of depression and anxiety, premenstrual syndrome, a negative attitude towards the baby, the reluctance of the baby's sex, and a history of sexual abuse
Obstetric risk factors : A high-risk pregnancy, hospitalization during pregnancy, and traumatic events during childbirth that include emergency Cesarean section, in-utero meconium passage, umbilical cord prolapse, preterm or low birth weight infant, and low hemoglobin
Social factors : Lack of social support, domestic violence in the form of spousal abuse (eg, sexual, physical, or verbal), smoking, and young maternal age during pregnancy [6]
Lifestyle : Poor eating habits, decreased physical activity and exercise, vitamin B6 deficiency (via its conversion to tryptophan and, later on, serotonin, which, in turn, affects mood), and lack of sleep; exercise decreases low self-esteem caused by depression and increases endogenous endorphins and opioids, which brings positive effects on mental health and improves self-confidence and problem-solving capacity. [7]
Family history of psychiatric disorders : Recent studies have shown that a family history of psychiatric disorders is a risk factor for developing postpartum depression. This increased risk is likely due to genetic and environmental factors during childhood and later life associated with a lack of social support, which is a risk for PPD. [8]
Epidemiology

Depression is the most common psychiatric condition of the peripartum period. Moreover, PPD is associated with an increased risk of parental suicide, which is the second most common cause of mortality postpartum. [9] PPD affects 6.5% to 20% of postpartum individuals globally. [10] The incidence varies based on contributing factors, including the country's cultural environment and economic conditions. Different studies have found varying risk factors for postpartum depression, resulting in little consistency between studies. [3] According to studies, depression occurs more commonly in adolescents, patients who deliver premature infants, and those living in urban areas. In a meta-analysis, the prevalence of postpartum depression was the highest in China, at 21.4%. In comparison, the prevalence in Japan was 14%, and the prevalence in the United States was 8.6%. The average time of onset of postpartum depression is 14 weeks postpartum. [3] Overall, Black and Hispanic patients tend to report the onset of symptoms within 2 weeks of delivery, unlike White patients, who more frequently report the onset of symptoms later.

Pathophysiology

The pathogenesis of PPD is currently unknown but is likely multifactorial. [10] Genetic, hormonal, psychological, and social life stressors have been suggested to play a role in PPD development. [11] [12] [13] The role of reproductive hormones in depressive behavior suggests neuroendocrine pathophysiology for PPD. Ample data advocating that changes in the reproductive hormones stimulate the dysregulation of these hormones in sensitive individuals has been documented. The pathophysiology of PPD can be caused by alterations of multiple biological and endocrine systems, for example, the immunological system, the hypothalamic-pituitary-adrenal axis (HPA), and lactogenic hormones.

The HPA is known to be involved in the disease process of postpartum depression. The HPA axis causes the release of cortisol in trauma and stress; with HPA axis dysfunction, the release of catecholamines is decreased, leading to a poor stress response. HPA-releasing hormones increase during pregnancy and remain elevated up to 12 weeks postpartum. Recent evidence suggests that PPD is linked to the gamma-aminobutyric acid (GABA) neurotransmission system. The imbalance in GABA, the chief inhibitory neurotransmitter in the brain, likely plays a role in causing PPD. [10]

The rapid drop in reproductive hormones like estradiol and progesterone following delivery can be a potential stressor in patients who are susceptible, and these changes can lead to the onset of depressive symptoms. Elevated cortisol levels and low tryptophan levels may be noted. [6] Oxytocin and prolactin also play an essential role in the pathogenesis of PPD. These hormones regulate the milk let-down reflex and the synthesis of breast milk. Failure to lactate and the onset of PPD are often observed to coincide. Low levels of oxytocin are particularly observed in PPD and unwanted early weaning. During the third trimester, lower levels of oxytocin are associated with increased depressive symptoms during pregnancy and following delivery. [14]

History and Physical

PPD is diagnosed when at least 5 depressive symptoms are present for at least 2 weeks. Most experts include the onset of symptoms that occur up to 12 months postpartum. [15] The following 9 symptoms in affected people may be present almost daily and represent a change from the previous routine; however, a PPD diagnosis should include either depression or anhedonia:

Depressed mood (subjective or observed) is present most of the day
Loss of interest or pleasure (anhedonia), most of the day
Sleep disturbances (insomnia or hypersomnia)
Psychomotor retardation or agitation
Worthlessness or guilt
Loss of energy or fatigue
Suicidal ideation or attempt and recurrent thoughts of death
Impaired concentration or indecisiveness
Change in weight or appetite (eg, a weight change of 5% over 1 month)

The symptoms can lead to significant distress and impairment. Furthermore, these symptoms are not attributable to substance use or a medical condition. A psychotic disorder does not cause the episode, nor has there been a prior manic or hypomanic episode. [9] The International Classification of Diseases-10 describes a depressive episode as follows:

In typical mild, moderate, or severe depressive episodes, the patient has a depressed mood with a decrease in activity and energy.
Capacity for enjoyment, interest, and concentration is reduced. The patient feels tired after minimum effort, with sleep disturbance and a decreased appetite. Guilt, worthlessness, lowered self-esteem, and lowered self-confidence are commonly present.
Somatic symptoms, including anhedonia, unusual waking in the very early morning, agitation, weight loss, loss of libido, decreased appetite, and marked psychomotor retardation are noted. These symptoms may vary daily and are not responsive to a change in circumstances.
A depressive episode may be classified as mild, moderate, or severe, depending on the severity and number of the symptoms.

The signs and symptoms of PPD are identical to nonpuerperal depression with an additional history of childbirth. Symptoms include depressed mood, loss of interest, changes in sleep patterns, change in appetite, feelings of worthlessness, inability to concentrate, and suicidal ideation. Women may also experience anxiety. Patients with PPD may also have psychotic symptoms, which include delusions and hallucinations, such as voices saying to harm infants. PPD may lead to poor maternal-infant bonds, failure of breastfeeding, harmful parenting practices, marital discord, as well as worse outcomes concerning the child's physical and psychological development. The remission of symptoms reduces the risk of behavioral and psychiatric problems in the offspring. A prior episode of PPD increases the future risk of major depression, bipolar disorder, and PPD. Past personal and family histories of PPD and postpartum psychosis should also be noted.

The American College of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics (AAP), and the American Academy of Family Medicine (AAFP) all recommend screening every patient for postpartum depression using the EPDS. [3] During the evaluation, the inclusion of drug and alcohol history, smoking habits, and all prescription and over-the-counter drug medications is essential. PPD screening should be performed during pregnancy and postpartum. [16]

Several screening tools are available, though the most frequently used is the EPDS, a 10-item questionnaire completed by patients within a few minutes. A score ≥13 is associated with an increased risk of developing PPD and provides the basis for additional clinical assessment. The objectives of the clinical evaluation are to constitute the diagnosis, assess suicidal and homicidal risks, and rule out other psychiatric illnesses. [17]

Treatment / Management

Prevention of postpartum depression in high-risk patients using counseling and cognitive behavioral therapy, as well as interpersonal therapy, has been effective. Clinicians should identify and implement these interventions as preventative measures for high-risk patients. [15]

Antidepressant Medications

The first-line treatment for peripartum depression is psychotherapy and antidepressant medications. Psychotherapy is the first-line treatment option for patients with mild to moderate peripartum depression. A combination of therapy and antidepressant medications is recommended for moderate to severe depression. Referral to a behavioral health resource may also be recommended. [15] ACOG recommends using selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants for PPD medical therapy. [9]

Selective serotonin reuptake inhibitors are the first choice medications for PPD. Consideration should be given to switching to serotonin-norepinephrine reuptake inhibitors or mirtazapine if selective serotonin reuptake inhibitors are ineffective. Sertraline or escitalopram are good first-line choices for medical therapy. Sertraline has extensive and reassuring safety research. Fluoxetine and paroxetine, if previously used effectively for a specific individual, may be considered despite an increased risk of neonatal adaptation syndrome. As such, the treatment for patients who have had successful medical therapy with an antidepressant in the past should be allowed to resume that effective medication during or after pregnancy. [15]

The goal of treatment for PPD is remission or resolution of symptoms of depression. The same screening tool should be used to track symptoms. An improvement of 50% or more defines a treatment response. Algorithms may be used to help in adjusting dosages of medications with continued use of the Patient Health Questionairre-9 or EPDS. Inadequately or untreated mental health conditions are associated with perinatal risks, as are any pharmacologic agents; the risks of both need to be recognized. The lowest effective dose of medication should be used to achieve illness remission. However, avoiding undertreatment, which is common in obstetrics, is critical. Polypharmacy and switching medications should be avoided if remission is possible with the use of a single agent. [15] Although benefits may be reported within 1 week of the start of oral therapy, symptom improvement may take 4 to 8 weeks. [9]

Once an effective dose is reached, continued treatment for at least 6 to 12 months is recommended to prevent relapse of symptoms. [18] Discontinuation of medical therapy during pregnancy or in the postpartum period results in a high risk of recurrence and is not recommended; also, discontinuing medication in the third trimester to mitigate the risk of neonatal adaptation syndrome is not recommended. Additionally, abrupt discontinuation of both selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors is associated with complications unless a progressive taper over 2 to 4 weeks is used. Discontinuation symptoms may include gastrointestinal upset, agitation, anxiety, headache, dizziness, fatigue, sleep disruption, tremors, myalgias, and electric-like shocks. [15]

Pharmacologic recommendations for people who are lactating should include discussing the benefits of breastfeeding, the risks of antidepressant use during lactation, and the risks of untreated illness. Repetitive transcranial magnetic stimulation is a treatment that may provide an alternative option for people who breastfeed and are concerned about their babies being exposed to medication. The risk of breastfeeding while taking a serotonin reuptake inhibitor is relatively low, and patients can be encouraged to breastfeed while on antidepressants. After 12 weeks, cognitive behavioral therapy, sertraline monotherapy, and combination therapy were helpful. The cognitive behavioral therapy monotherapy group found the most accelerated initial gains after treatment startup.

Neurosteroid Therapy

Brexanolone, an intravenous neurosteroid that positively acts at the GABA-A receptors, was approved by the Food and Drug Administration (FDA) in March 2019, specifically for PPD. Brexanolone may be considered for use with moderate to severe depression in the third trimester or postpartum. Patients must be enrolled in the Risk Evaluation and Mitigation Strategy Program. [19] Brexanolone has a rapid onset of action but is hard to access and may be cost-prohibitive. No data supports its safety with breastfeeding or efficacy beyond 30 days of use. Inpatient monitoring for increased sedative effects, sudden loss of consciousness, and hypoxia during infusion is required. [9] [15]

Brexanolone, an analog of allopregnanolone, a metabolite of progesterone, was the first medication approved by the FDA for the treatment of moderate to severe postpartum depression. [19] Brexanolone is administered intravenously as a continuous 60-hour infusion lasting approximately 2.5 days. Multiple clinical trials demonstrate that brexanolone is usually well-tolerated in women with moderate to severe PPD and can provide a rapid beneficial response. [20] [21] Breastfeeding is not recommended during and for 4 days after brexanolone infusion therapy. More clinical trials are needed to assess further the long-term safety and efficacy of brexanolone in treating PPD. [15]

Zuranolone, a neuroactive steroid like brexanolone, is also a GABA-A receptor modulator that was FDA-approved on August 4, 2023, for PPD management. A 50-mg oral dose every night is given with a fat-containing (700 cal; 30% fat) meal for 14 days. Zuranolone may be used alone or in combination with oral antidepressants. The onset of action is rapid, from hours to days, which helps give more immediate relief. Because of the central nervous system depression seen with zuranolone, patients should be counseled that their driving ability may be reduced. Also, zuranolone has been suggested to produce harmful effects on the fetus during pregnancy and lactation. Overall, zuranolone is well tolerated and has minimal side effects. [10] The most common adverse event reported by over 26% of patients was somnolence. [22] Because safety and effectiveness have not yet been studied, zuranolone is not recommended to be continued for longer than 14 days.

Nonpharmacologic Therapies

Transcranial magnetic stimulation is a noninvasive procedure that uses magnetic waves to stimulate and activate nerve cells in a targeted area of the brain. [23] These cells are underactive in people with major depression. Transcranial magnetic stimulation is usually done once a day for 4 to 6 weeks to be effective. This therapy may be used in patients who are not responding to antidepressants and psychotherapy. Generally, transcranial magnetic stimulation is safe and well-tolerated, but some side effects can include headaches, lightheadedness, scalp discomfort, and facial muscle twitching. Some serious side effects are rare, including seizures, hearing loss if ear protection is not adequate, and mania in people with bipolar disorder. [24] Although early results are promising, future studies are needed to address the benefits of transcranial magnetic stimulation for PPD. [23]

Patients with severe PPD may not respond to psychotherapy and pharmacotherapy. For patients refractory to 4 consecutive medication trials, electroconvulsive therapy (ECT) may be recommended. ECT is beneficial in patients with psychotic depression, with intent or plans on committing suicide or infanticide, and refusal to eat, leading to malnutrition and dehydration. [25] [26] Several observational studies have suggested ECT as a safer option for lactating patients as there are fewer adverse events for the mother and the infant. [27] [28] Other authors are not as supportive of ECT use for PPD.

Differential Diagnosis

Differential diagnoses that should also be considered when evaluating postpartum depression include:

Baby blues: Baby blues most commonly occur within a week after delivery and resolve within a few days, around day 10 to 14 postpartum. Approximately 50% to 75% of patients experience baby blues, which are temporary and require no treatment. Symptoms may include crying bouts, sadness, anxiety, irritability, sleep disturbance, appetite changes, confusion, and fatigue. The baby blues does not affect daily functioning or the ability to care for the baby. However, severe postpartum baby blues is associated with a risk for PPD. [29]
Hyperthyroidism and hypothyroidism: These conditions can also lead to mood disorders. Thyroid disorders can be assessed by testing thyroid-stimulating hormone levels.
Postpartum anxiety, adjustment disorder, or posttraumatic stress disorder: Postpartum anxiety focuses on excessive worry. Adjustment disorder includes emotional and behavioral responses to the stress of childbirth, which are less severe and shorter in duration than PPD. Posttraumatic stress disorder involves trauma-related symptoms due to a traumatic birth experience.
Postpartum psychosi s: Postpartum psychosis is defined as the onset of psychosis during the first 4 weeks postpartum. Most women do not have a known history of psychiatric disorders, but some have had bipolar disorder in the past. Usually, onset is within 3 to 10 days postpartum but may occur over 4 weeks postpartum. Postpartum psychosis is a psychiatric emergency with potential suicide and infanticidal risk. A patient can experience hallucinations, agitation, unusual behavior, disorganized thoughts, and delusions. This is a rare disorder, occurring in only 1 to 2 per 1000 pregnancies, and presents with an acute onset of manic or depressive psychosis within the first few days or weeks after delivery. [15]

Dose adjustments may be needed based on monitoring symptoms through clinical assessment, validated screening tools, or both. Due to increased renal clearance, increased distribution volume, and changes in enzyme activity with advancing gestation, an increase in medication dose during pregnancy may be required. Empiric down-titration of psychiatric medications in the third trimester is not recommended as neonatal outcomes were not improved, and the associated risk of worsening mental health conditions was noted. [15]

A pivotal factor in the duration of PPD is delayed treatment. Approximately 25% of patients with perinatal depression will have symptoms for 3 years after giving birth. [15] PPD has repercussions beyond possible physical harm to the child. Data reveal that the condition also affects parent-infant bonding. Often, the child is treated inappropriately with a negative attitude that can significantly impact the child's growth and development. Children born to patients with PPD have been found to exhibit marked changes in behavior, altered cognitive development, and early onset of depressive illness. More importantly, these children may struggle with obesity and dysfunction in social interactions.

Complications

PPD affects the parents and the infant and can lead to a chronic depressive disorder if untreated. Even if treated, PPD can be a risk for future episodes of major depression. Moreover, PPD is a stressful event for the entire family, as children may be affected also. Children of parents who have untreated depression can develop behavioral and emotional problems, including language development delays, which are commonly seen, sleeping problems, eating difficulties, excessive crying, and attention-deficit/hyperactivity disorder.

When untreated, PPD is associated with negative consequences for those who are postpartum, including disrupted health behaviors, relationships, physiology, and parenting. This results in a risk for the fetus, the partner, and the whole family. [15] Therefore, ACOG does not recommend withholding or stopping psychiatric medications due to pregnancy status alone. [15]

Deterrence and Patient Education

Deterrence and education are critical components in addressing PPD. Proactive education about PPD should begin during prenatal care, with clinicians informing expectant mothers and their families about the signs, symptoms, and potential risks associated with this condition. By increasing awareness, new mothers can recognize the onset of PPD early and seek timely intervention. Education programs can include prenatal classes, informational brochures, and discussions during regular medical appointments. Additionally, integrating mental health screenings into postpartum checkups can help in early detection and management.

Support systems, including counseling services and support groups, should be readily accessible to new mothers, providing a safe space for them to share experiences and receive professional guidance. By fostering an environment of understanding and support, the stigma associated with PPD can be mitigated, encouraging more women to seek help. Ultimately, comprehensive deterrence and educational strategies are essential in reducing the incidence and severity of postpartum depression, ensuring healthier outcomes for mothers and their infants.

Pearls and Other Issues

Before delivery, many patients who are at risk of developing PPD can be identified. These patients, along with their families, should be provided with information and education regarding PPD prenatally. The information should be reinforced during postpartum hospitalization and after discharge. [5] Childbirth education classes teach new parents to seek help and the support that they might need for childbirth. By teaching patients and their partners about the signs and symptoms of PPD, educators can increase the chance that the patient with this condition receives proper treatment.

Screening for depressive symptoms can be done during pregnancy. This screening can identify women who are at increased risk for developing PPD. Exclusive breastfeeding has a positive effect on reducing depressive symptoms from childbirth to 3 months. PPD can be prevented when parents are given positive parenting lessons and when the parent-infant bond is promoted and increased. This can be achieved through social support from family and clinicians.

Enhancing Healthcare Team Outcomes

To enhance patient-centered care, outcomes, patient safety, and team performance related to PPD, an interprofessional approach involving physicians, advanced practitioners, nurses, pharmacists, and other health professionals is crucial. Due to the high morbidity of PPD, current efforts emphasize prevention. Nurses are in a primary position to identify patients at high risk for postpartum mood disorders even before delivery. During admission, nurses can identify patients with a history of depression or postpartum blues and monitor those who develop depression during pregnancy. These patients require education on available treatments and support from the postpartum nurse or primary care clinician. Coordination with therapists and referrals to psychiatrists for antidepressant treatment may be necessary.

Pharmacological and nonpharmacological prophylaxis are used with variable success, but evidence shows that postpartum parents who are treated have better bonding experiences with their infants. Additionally, untreated parental depression can lead to mood and behavior problems and obesity in children. Despite awareness, many patients remain untreated due to a lack of follow-up. Therefore, the role of the postpartum visiting nurse is critical in ensuring ongoing support and care. Effective interprofessional communication and care coordination among clinicians are essential in identifying, monitoring, and treating PPD, ultimately improving patient outcomes and safety.

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Disclosure: Karen Carlson declares no relevant financial relationships with ineligible companies.

Disclosure: Saba Mughal declares no relevant financial relationships with ineligible companies.

Disclosure: Yusra Azhar declares no relevant financial relationships with ineligible companies.

Disclosure: Waquar Siddiqui declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

Cite this Page Carlson K, Mughal S, Azhar Y, et al. Postpartum Depression. [Updated 2024 Aug 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Open access
Published: 03 September 2024

The prevalence and related factors of post-partum anxiety and depression among mothers during COVID-19 pandemic in 2021

Masoomeh Salimian 1 ,
Mohammad Javad Tarrahi 2 ,
Tahmineh Dadkhahtehrani 3 &
Masoumeh Pirhady 3

BMC Public Health volume 24 , Article number: 2394 ( 2024 ) Cite this article

Metrics details

There are many factors effective on occurrence of post-partum anxiety and depression. COVID-19 pandemic, as a major health crisis, affected many countries and had undesirable mental health outcomes, especially for the vulnerable population. The aim of this study was to evaluate the prevalence of post-partum anxiety and depression and their related factors during COVID-19 pandemic.

The present descriptive cross-sectional study was conducted on 360 mothers who delivered their child during COVID-19 pandemic and had referred to the comprehensive urban health canter of Lenjan city two months after their delivery (from November 10th, 2021, until March 19th, 2022). Data were gathered using 3 questionnaires including demographic characteristics, Edinburgh Postnatal Depression Scale (EPDS), and Beck Anxiety Inventory (BAI). Data were analyzed using SPSS software version 24 and the level of significance was set at p < 0.05.

The prevalence of anxiety and post-partum depression was 27% and 20%, respectively. None of the demographic characteristics had a significant relationship with anxiety and depression. Related factors to post-partum anxiety included desired pregnancy, premenstrual syndrome, marital conflicts, history of mother’s hospitalization due to COVID-19, compliance rate with preventive health measures for COVID-19, stressful events, and social support.

It is suggested to screen mothers to detect significant related factors of post-partum anxiety and depression in other future pandemics or epidemics to support them.

Peer Review reports

Introduction

Post-partum blues is common among mothers and if it lasts more than 10 days, it would be called post-partum depression. Post-partum depression is a common but treatable problem with widespread effects on mothers and their families which is associated with feeling of sadness, inability to have pleasure, irritability, anger, and decreased self-confidence. Symptoms of this disorder are mood swings, changes in appetite, fear of getting hurt, serious concerns about the baby, extreme sorrow and crying, hesitation, concentration problem, becoming uninterested in daily activities, sleep disorder and death and suicidal thoughts [ 1 ]. This disorder would also lead to decrease the level of healthy relationship and attachment between mother and the infant, infant’s growth disorder, decreased level of mother’s health, permanent depression of mother and marital conflicts [ 2 ]. The risk of depression relapse following delivery has been reported as 40% [ 3 ]. The prevalence of this disabling disorder in the world has been reported from 5 to 60.8% [ 1 ]. According to the results of previous studies, the prevalence of post-partum depression varies in the world, in a way that, up to 2017, it was about 9.5% in high-income countries, 20.8% in average-income countries, and 25.8% in low-income countries [ 4 , 5 ]. In 2020, in Asian countries, the prevalence of post-partum depression was reported from 7 to 33% [ 6 ]. Considering its high prevalence and harmful outcomes, post-partum depression has been recognized as one of the most severe global health problems during the past decade [ 3 ].

Evidence has shown that, following extensive prevalence of infectious diseases, psychological disorders would also appear. Psychological reactions to pandemics include inconsistent behaviors, emotional distress and defensive responses such as anxiety, fear, disappointment, anger, boredom, depression, stress, and avoidance behaviors [ 7 ]. COVID-19 pandemic was also a major health crisis; therefore, it could be expected that it would be associated with undesirable psychological outcomes especially in the vulnerable groups such as pregnant women [ 8 ]. The review articles by Usmani (2021) in Turkey showed that the prevalence of post-partum depression during COVID-19 pandemic was from 7 to 80.8% [ 9 ]. Also, in Romania, during the COVID-19 pandemic in 2020, this prevalence was 18.8% [ 10 ].

Anxiety is also an undesirable and vague feeling which usually appears in the form of concern and is defined as a sense of hesitation towards an unknown factor. This undesirable feeling could be associated with many physiologic, emotional and mental symptoms and be expressed in the form of a severe emotional feeling. Post-partum anxiety and anxiety disorders are common among women [ 1 , 11 ]. According to a review article by Rujcumar (2020) in India, the prevalence of anxiety and depression among general population was 16–28% during COVID-19 pandemic, and were among the most common psychological problems [ 12 ].

Studies have that various factors have been related to anxiety and post-partum depression. For example, based on the systematic review by Usmani (2021), the risk factors for post-partum depression during COVID-19 pandemic were divided into 6 categories: social-demographic, psychological, previously existed psychological disorders, metabolic factors, abortion, and incorrect information from media [ 9 ]. Study by Xiong (2020) on post-partum mothers in China showed that the probability of anxiety and depression among mothers who were students, had background diseases, and had poor health conditions, was higher [ 13 ]. Gurudatt (2014) in their study reported higher prevalence of depression among working mothers during the first months following delivery in comparison to non-working mothers [ 14 ]. Probably, there were some other effective factors during COVID-19 pandemic.

Aim and objectives

Since, very few studies have been conducted in Iran about the prevalence of and related factors to anxiety and post-partum depression during COVID-19 pandemic and the effect of these disorders on the health of mothers and infants, such studies could lead to development of beneficial interventions during future pandemics/epidemies. Therefore, this study was conducted to evaluate the prevalence of and related factors to post-partum anxiety and depression during COVID-19 pandemic in Lenjan city of Isfahan Province, Iran in 2021.

Study design

This study was a descriptive cross-sectional study conducted on all mothers who had delivered during COVID-19 pandemic in 2021 and had referred to the comprehensive urban health center of Lenjan two months after delivery for the vaccination of their infants. Sampling was conducted from November 10th 2021 until March 19th 2022. This study was conducted after the start of vaccination of pregnant women (August 12th 2021) against COVID-19 in Iran.

Study sample

Since the number of births during 2020 in Lenjan was 3020 infants, the number of participants was calculated to be 360 individuals; using the following formula with a 30% expected prevalence and 5% error probability:

Study recruitment

mother’s willingness to participate in the study

having Iranian nationality

having no history of mental diseases

no consumption of antidepressant and antianxiety drugs according to mother’s statements and information from SIB website

having no history of drug addiction

no abnormalities in the last infant

having no history of infertility related to the last pregnancy

not responding to more than 5% of the questions

Data collection

In this study, the mothers were selected using random cluster multistage sampling method from comprehensive urban health centers of Lenjan city, Iran. It must be noted that there are 12 comprehensive health centers, 11 health bases, 21 health houses and 22 dependent villages in Lenjan city. From all the health houses and dependent villages which were 43 centers, 10 were randomly selected and from each health house, 4 to 5 participants were randomly selected and completed the questionnaires. Also, from a total of 23 health center and health base, 14 were randomly selected and from each, 16–28 mothers completed the questionnaires, based on the number of mothers who had delivered their infants there. So, mothers who have given birth and had two-month-old infants were enrolled in the study. For this matter, name of the mothers who had two-month-old infants or their infants would become two-month-old in the future was listed and a number was assigned to each of them. By dividing the number of mothers by the number of needed samples, the space between the samples was calculated. Then, by selecting a number from the calculated space from the list of the names and adding it to the calculated space between the samples, the number of the mothers who were intended for the study was achieved. When their infants reached the age of two months, mothers were invited for completing the questionnaires.

Instruments

Data were gathered using 4 questionnaires that were completed by the mothers in the presence of the researcher.

Demographic questionnaire

Demographic questionnaire included 7 items: age, education level, occupation, parity, husband’s education level, family income, and husband’s occupation.

Questionnaires of dependent variables (depression and anxiety)

Edinburgh Postnatal Depression Scale (EPDS) was applied to assess mothers’ depression. It has been used in various studies and its validity and reliability have been approved. This scale contains 10 multiple-choice questions which are scored from 0 to 3 based on a 4-point Likert scale, with a total number of 0 to 30. Higher total scores indicate higher level of depression and the threshold for depression is the score of 10. Scores of 10 to 16 indicate mild depression, 17 to 23 indicate moderate depression and 24 to 30 indicate severe depression [ 13 , 15 , 16 ]. Cronbach’s α for Edinburgh Scale was calculated through a validation study in Iran to be more than 0.7 and its reliability along with Beck Scale was 0.44 [ 17 ].

Beck Anxiety Inventory (BAI) was applied to assess mothers’ anxiety. It evaluates specifically the severity of symptoms of clinical anxiety in patients with 21 questions scored from 0 to 3 based on a 4-point Likert scale. The total score ranges from 0 to 63. The threshold for anxiety is the score of 8. Scores from 0 to 7 indicate no or low anxiety, scores from 8 to 15 indicate mild anxiety, scores from 16 to 25 indicate moderate anxiety and scores from 26 to 63 indicate severe anxiety [ 18 ]. Its Cronbach’s α was calculated to be 0.87 to 0.92, its validity was calculated as 0.75 using test-retest method after one week and the correlation of its items varied from 0.30 to 0.76. In present study, the data analyzer hade to concatenate the levels of depression and anxiety and reported tables included two rows (yes or no). In the rows related to anxiety and depression, “Yes” means that participant has mild, moderate, or sever status.

The questionnaire of independent variables

The questionnaire of independent variables included 12 variables nonrelated to COVID-19 pandemic (Table 1 ) and 12 variables related to COVID-19 pandemic (Tables 2 and 3 ). Out of first 12 variables, social support and stressful events of life were assessed by previously developed questionnaires. Social support questionnaire developed by Phillips et al. consists of 43 items scored from 1 to 4 (completely disagree- completely disagree) based on a 4-point Likert. The items of 3, 10, 13, 21, and 22 score reversely. Higher scores show more social support. Its reliability was confirmed in a study in Iran (Cronbach’s α 0.74) [ 19 ]. Also, stressful events of life were assessed by questionnaire of stressful events developed by Thomas Holms and Richard Rahe in 1976. This questionnaire includes 43 items scored from 1 to 4 (very mild- sever) based on a 4-point Likert. The scores 0-149, 150–199, 200–299, and 300 or more indicate very mild, mild, moderate, and sever stress respectively. It has a satisfying reliability (Cronbach’s α 0.79) as well as face and content validity. In Iran, its reliability was confirmed by calculating Cronbach’s α (0.72) and split – half method (0.64) in a study [ 20 ].

The variables related to COVID-19 pandemic ( n = 12) were achieved based on review of literature and the opinions of academic members of midwifery and obstetrics/gynecology including: history of mother’s definite infection with COVID-19 based on PCR test, history of definite infection with COVID-19 among close relatives of mothers based on PCR test, history of mother’s hospitalization due to COVID-19, history of hospitalization due to COVID-19 among mother’s family members and intimate friends/relatives, history of mortality due to COVID-19 among mother’s family members and intimate friends/relatives, history of mortality due to COVID-19 among mother’s non-intimate friends and relatives, following COVID-19 news by the mother, compliance with preventive health measures for COVID-19, being in contact with someone without compliance with preventive health measures COVID-19, vaccination of mother’s family members and intimate friends/ relatives with close contacts, mother’s vaccination against Covid-19, and the reason for mother’s lack of vaccination against Covid-19. One of above mentioned variables was “compliance rate with preventive health measures for COVID-19 by participants”. To assess this variable, a 16-item questionnaire was developed by the research team and its validity was assessed through calculating the Content Validity Ratio and Content Validity Index based on the opinions of 10 faculty members of Health and Nursing/Midwifery Faculties of the university. After modifications, the 14-item questionnaire was achieved with satisfactory Cronbach’s alpha (0.87) (Table 4 ). The questions score from 1 to 4 based on a 4-point Likert scale, with a total number of 14 to 56. Higher total scores indicate higher compliance rate and 14–34 indicates “yes” and 35–56 indicates “no” compliance.

Statistical analyses

Data analysis was conducted using descriptive statistics (mean and standard deviation) and chi square test. P values less than 0.05 were considered statistically significant and data analysis was conducted by SPSS software version 24. In this study, the data analyzer hade to concatenate the levels and reported tables included two rows (yes or no) because the numbers in some rows were less than 6.

Demographic characteristics

The mean age of the participants was 31.05 ± 5.37 years (16–43 years). Most of them had diploma (45%) and were housewife (89.41%), and multiparous (60.83%). Most of the husbands were self-employed (37.67%). Most of them had a moderate family’s income (51.5%).

Results of this study showed that most of the mothers did not have post-partum anxiety (73%) and distribution of anxiety severity was as follows: 18.7% of mothers had mild anxiety, 4.5% had moderate anxiety, and 3.9% severe anxiety (27% in total). The mean score of mothers’ anxiety was at the no anxiety level (5.60 ± 7.8). Also, results indicated that most of the mothers did not have depression (80%) and distribution of depression was as follows: 15.30% had mild depression, 3.60% hah moderate depression and 1.10% had severe depression (20% in total). The mean score of mothers’ depression was at the no depression level (5.34 ± 5.38).

Also, results showed that post-partum anxiety in mothers had no significant relationship with demographic variables including age, educational level, occupation, parity, husband’s occupation, and family’s income.

Out of independent variables nonrelated to COVID-19 pandemic, intention status of recent pregnancy ( p < 0.001), history of premenstrual syndrome ( p < 0.001), marital conflict ( p < 0.001), stressful events ( p < 0.001), and social support ( p = 0.014) showed significant relationships with anxiety. Also, out of them, the history of premenstrual syndrome ( p < 0.001), history of chronic diseases of the mother ( p = 0.014), marital conflict ( p < 0.001), stressful events ( p < 0.001), and social support ( p < 0.001) showed significant relationships with depression. (Table 1 )

Out of independent variables related to COVID-19 pandemic, history of hospitalization due to COVID-19 among mother’s family members, intimate friends/relatives ( p = 0.021) and compliance with preventive health measures showed significant relationships with anxiety ( p = 0.008). (Table 2 ) Also, out of them, the history of mother’s hospitalization due to COVID-19 ( p = 0.038) and compliance with preventive health measures showed significant relationships with depression ( p < 0.001). (Table 3 )

The results of the present descriptive cross-sectional study showed that the level of anxiety among studied mothers two months after delivery was 27%. In a study that was conducted in Kashan on pregnant women during COVID-19 pandemic, the level of anxiety was 18.71% and in another study in Ahwaz conducted from March 20th to April 10th 2020, the level of anxiety was 22.3% [ 21 , 22 ]. The above-mentioned studies were conducted while vaccination has not yet been started for general population and pregnant mothers but this study was conducted after vaccination was started; however, results showed that the prevalence of anxiety was higher in this study which might have been due to the differences between the study environments.

In this study the level of depression was 20%. Also, the results of another study in Singapore during COVID-19 pandemic in 2021 showed that the rate of depression was 17% [ 23 ]. In the systematic review by Rajkumar in India (2020) the level of depression was from 16 to 28% [ 13 ] and in the systematic review by Usmani (2021) from Turkey, that was titled evaluation of risk factors for post-partum depression during COVID-19 pandemic, the rate of post-partum depression during the pandemic was reported from 7 to 80.8% [ 9 ]. The reason for difference in the results of studies might be due to the different time of sampling (disease outbreaks or the gap between outbreaks), study environment, cultural, economic, and social difference as well as different intervals between delivery and sampling.

The results of this study showed no significant relationship between anxiety and depression and mother’s occupation which were in line with the results of two studies conducted on pregnant women during COVID-19 pandemic, one by Saadati in Ahwaz (2020) and another by Karimi (2021) in Tehran [ 22 , 24 ]. On the contrary, Guvenc et al. (2021) in a study that was conducted on post-partum anxiety and depression during COVID-19 pandemic in Turkey revealed that working pregnant women were more prone to post-partum depression [ 25 ]. The reason for this difference might be due to the difference between the participants of the studies. In this study most of participants were housewife and even though the study was conducted during the COVID-19 pandemic, but it was after the vaccination was started and individual’s concerns were reduced, and therefore, working women were less concerned about getting out of the house; but the study by Guvenc et al. (2021) was conducted during the time that people were more willing to stay in the house to prevent infection with COVID-19 and therefore, working women were more likely to develop depression.

The results of this study showed that post-partum anxiety had a significant relationship with the pregnancy being wanted or unwanted; but it was in contrast with the results of the study by Karimi (2021) in Iran during the COVID-19 pandemic which showed no significant relationship between wanted or unwanted pregnancies and mother’s anxiety [ 24 ]. It seems that mothers who were not willing to get pregnant during the COVID-19 pandemic were concerned about the problems of raising a child during pandemic, and therefore, unwanted pregnancies were associated with more anxiety in mothers.

On the other hand, the reason for different results might be due to cultural differences, social support and number of participants. Also, this study was conducted on women after delivery and the above-mentioned study was conducted on pregnant women.

According to the results of this study, post-partum depression and anxiety had a significant relationship with premenstrual syndrome; meaning that the prevalence of premenstrual; syndrome was higher among anxious and depressed mothers than mothers with low levels of anxiety and depression. Results of this study were in line with the study by Alimoradi (2019) which indicated a significant relationship between the history of premenstrual syndrome and post-partum depression [ 26 ].

The results of this study showed a significant relationship between anxiety and depression and having marital conflicts. Results of this study were in line with the study by Effati Daryani (2020) in Tabriz, which reported marital conflicts as a predictor of anxiety in pregnant women during the COVID-19 pandemic [ 27 ]. The study of Seymour (2015) which was conducted in Australia to evaluate the risk factors for anxiety and parenting during the first year of child’s birth, revealed that low quality of marital relationship and having marital conflicts were significantly associated with higher levels of mother’s anxiety. These results were in line with the results of this study [ 28 ].

This study also indicated a significant relationship between anxiety and the history of COVID-19 related hospitalization of mother’s relatives. The study of Abedzadeh in Kashan (2021), also showed that history of infection of family members with COVID-19 and concerns about infection of herself and her infant were predictors of anxiety score of pregnant women during the COVID-19 pandemic. These results were in line with the results of this study [ 21 ].

This study showed that anxiety and depression had significant relationships with observing preventive health measures by the mother during the pandemic; meaning that, mothers who did not observe preventive health measures had higher levels of anxiety and depression. Results of the study by Xiong (2020) which was titled evaluation of prevalence of and related factors to post-partum depression during the COVID-19 pandemic in women, in Guangzhou of China, indicated that observing preventive health measures had a positive psychological effect. It was in line with the results of this study [ 13 ]. Also, the study of Zanardo (2020) in Italy on mothers after their delivery during the COVID-19 pandemic showed that being concerned about getting infected with COVID-19 along with conducted quarantine measures during the pandemic had a negative effect on mothers’ thoughts and emotions after delivery and worsened the symptoms of depression; but, in contrast, in this study, not observing preventive health measures by mothers were associated with higher levels of depression [ 29 ]. The reason for this difference might be due to the differences in the time and place of sampling and also differences in the living environments of the mothers.

This study revealed that mothers’ post-partum anxiety and depression had a significant relationship with stressful events of life; in a way that mothers who had experienced more stressful events had higher levels of anxiety. In the study of Abedzadeh (2021), during the COVID-19 pandemic, perceived stress was one of the predictors of anxiety score in pregnant mothers [ 21 ]. This result was in line with the result of our study.

Also, this study indicated a significant relationship between post-partum anxiety and depression and perceived social support; in a way that, the prevalence of anxiety was higher among mothers who had received less social support. In this regard, the study of Pandey (2020) from Ethiopia about related factors to general anxiety among mothers receiving prenatal services revealed that poor social support had a significant relationship with general anxiety disorder [ 30 ]. Also, the study of Abuhammad (2024) in Jordan aimed to compare the levels of post-partum depression between Arab women residing in Jordan and the United States and the effect of social support on post-partum depression during the COVID-19 pandemic, showed a significant correlation between depression and social support; meaning that, increased social support was associated with decreased depression. The above mentioned results were in line with the results of this study [ 31 ]. No published studies are available that showed contrasting results.

Moreover, this study revealed a significant relationship between mother’s post-partum depression and history of having chronic diseases; meaning that, mothers with chronic diseases had higher levels of depression. It seems that suffering from chronic diseases and obligation to consume drugs for a long period of time and receiving constant medical care would lower the mental health and increase the chance of depression in some women. Results of the study by Suarez-Rico (2021), which was conducted on Mexican women after delivery during the COVID-19 pandemic, were in contrast with the results of this study [ 32 ]. In the above-mentioned study, having chronic hypertension and pregestational diabetes were evaluated.

Furthermore, results of this study indicated a significant relationship between mother’s post-partum depression and her hospitalization while infected with Covid-19; meaning that, mothers who were hospitalized due to COVID-19 infection had higher levels of depression. Since mothers who were severely infected with COVID-19 had to be hospitalized and, in these cases, the possibility of mortality was higher, it was expected that the level of depression would be higher among them. No other published study has examined this correlation.

Strengths and limitations

The strength point of this study was evaluation of the relationship between post-partum depression and anxiety with variables that have not been noticed in other studies (such as the place of care for mothers infected with COVID-19 and history of hospitalization of mother’s relatives due to COVID-19). One of the limitations of this study was that its environment was limited to a small town and its related villages which could affect the generalization of the results; furthermore, this study was conducted after vaccination was started which might have reduced the concerns in general population and mothers and have reduced the level of depression and anxiety in them.

Conclusions

Results of this study showed that most of the mothers had no anxiety and depression and the prevalence of post-partum anxiety and depression were 27% and 20%, respectively. Also, the mean scores of anxiety and depression were in the level of no anxiety and depression.

Related factors to post-partum anxiety in this study were desirability of pregnancy, history of premenstrual disorder, marital conflicts, history of hospitalization of mother’s relatives due to COVID-19, compliance rate with preventive health measures for COVID-19 by the mother during the COVID-19 pandemic, stressful events, and family support.

Related factors to post-partum depression in this study were history of premenstrual syndrome, having chronic diseases, marital conflicts, and history of mother’s hospitalization when infected with COVID-19, compliance rate with preventive health measures for COVID-19 by the mother during the COVID-19 pandemic, stressful events, and family support.

Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. “The questionnaire of the compliance rate with preventive health measures for COVID-19”, developed by the research team, was written in the text.

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Acknowledgements

We thank all mothers that participated in the study as well as all staffs of the health centers and health houses involved in the study and Research Deputy of Isfahan University of Medical Sciences.

This study was approved (approval number: 3400547) and financially supported by the Research Deputy of Isfahan University of Medical Sciences.

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School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

Masoomeh Salimian

Department of Epidemiology and Biostatistics, School of Health, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Mohammad Javad Tarrahi

Nursing and Midwifery Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Tahmineh Dadkhahtehrani & Masoumeh Pirhady

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Tahmineh Dadkhahtehrani, Mohammad Javad Tarrahi, and Masoume Salimiyan contributed to the study conception and design. Masoume Salimiyan was responsible for the recruitment. Data analysis was performed by Mohammad Javad Tarrahi. The first draft of the manuscript was written by Tahmineh Dadkhahtehrani, Masoume Salimiyan, and Masoume Pirhadi. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Tahmineh Dadkhahtehrani .

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This study was approved by the ethics committee of Isfahan University of Medical Sciences (IR.MUI.RESEARCH.REC.1400.325). In accordance with the Declaration of Helsinki written informed consent was obtained from all the participants, questionnaires were anonymous and confidentiality of the data was considered. Health considerations were observed for mothers and infants at the time of completing the questionnaires.

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Salimian, M., Tarrahi, M.J., Dadkhahtehrani, T. et al. The prevalence and related factors of post-partum anxiety and depression among mothers during COVID-19 pandemic in 2021. BMC Public Health 24 , 2394 (2024). https://doi.org/10.1186/s12889-024-19843-6

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Received : 19 May 2024

Accepted : 21 August 2024

Published : 03 September 2024

DOI : https://doi.org/10.1186/s12889-024-19843-6

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The prevalence and related factors of post-partum anxiety and depression among mothers during COVID-19 pandemic in 2021

Introduction

Aim and objectives

Study design

Study sample

Study recruitment

Data collection

Instruments

Demographic questionnaire

Questionnaires of dependent variables (depression and anxiety)

The questionnaire of independent variables

Statistical analyses

Demographic characteristics

Strengths and limitations

Conclusions

Data availability