Postpartum depression: a scoping review of epidemiology, determinants, pathophysiological mechanisms and management
DOI:
https://doi.org/10.18203/issn.2454-2156.IntJSciRep20261491Keywords:
Postpartum depression, Postnatal depression, Maternal mental health, Risk factors, Prevention, ManagementAbstract
Postpartum depression (PPD) is a common maternal mental health problem with significant consequences for mothers, infants, and families. Despite growing research, evidence remains fragmented across different domains, limiting a comprehensive understanding. This scoping review aimed to map and synthesize the existing literature on the epidemiology, determinants, pathophysiological mechanisms, and prevention and management strategies of postpartum depression. A scoping review was conducted following the framework proposed by Arksey and O’Malley and reported in accordance with PRISMA-ScR guidelines. A comprehensive search of PubMed, Scopus, and Google Scholar was performed for studies published between 2000 and 2025. Studies addressing postpartum depression in terms of prevalence, risk factors, biological mechanisms, and interventions were included. Data were extracted and synthesized thematically. A total of 33 studies were included in the review. The global prevalence of postpartum depression was estimated at approximately 17%, with higher rates observed in low- and middle-income countries. Key determinants included antenatal depression, psychosocial stressors, lack of social support, and obstetric complications. Pathophysiological mechanisms involved hormonal withdrawal, hypothalamic-pituitary-adrenal axis dysregulation, neurochemical alterations, and inflammatory processes. Prevention strategies focused on early screening, psychosocial interventions, and the management of modifiable risk factors. Management approaches included psychological therapies, pharmacological treatment, and emerging therapies such as neurosteroid-based interventions. Postpartum depression is a complex condition that needs integrated, multidisciplinary strategies for effective prevention and management. Enhancing early screening, increasing access to mental health services, and implementing tailored, context-specific interventions are crucial to lowering the global burden of postpartum depression.
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References
World Health Organization. Postpartum depression: an overview of treatment and prevention. 2011. Available at: https://www.gfmer.ch /SRH-Course-2011/maternal-health/Postpartum-depression-Corey-2011.htm. Accessed on 10 February 2026.
Vahia VN. Diagnostic and statistical manual of mental disorders 5: a quick glance. Indian J Psychiatry. 2013;55(3):220-3. DOI: https://doi.org/10.4103/0019-5545.117131
World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. 1992. Available at: https://www.who.int/publications/i/ item/9241544228. Accessed on 10 February 2026.
Liu X, Wang S, Wang G. Prevalence and risk factors of postpartum depression in women: a systematic review and meta-analysis. J Clin Nurs. 2022;31(17–18):2665-77. DOI: https://doi.org/10.1111/jocn.16121
Shelke A, Chakole S. Risk factors of postpartum depression in India and its management: a review. Cureus. 2022;14(9):e29115. DOI: https://doi.org/10.7759/cureus.29150
Amer SA, Zaitoun NA, Abdelsalam HA, Almasry SM, Elbanna TA, Abdellatif MM, et al. Exploring predictors and prevalence of postpartum depression among mothers: a multinational study. BMC Public Health. 2024;24(1):1308. DOI: https://doi.org/10.1186/s12889-024-18502-0
Khamidullina Z, Marat A, Muratbekova S, Mustapayeva NM, Chingayeva GN, Shepetov AM, et al. Postpartum depression epidemiology, risk factors, diagnosis, and management: an appraisal of the current knowledge and future perspectives. J Clin Med. 2025;14(7):2418. DOI: https://doi.org/10.3390/jcm14072418
Panolan S. Prevalence and associated risk factors of postpartum depression in India: a comprehensive review. J Neurosci Rural Pract. 2024;15(1):1-7. DOI: https://doi.org/10.25259/JNRP_584_2023
George M, Johnson AR, Sulekha T. Incidence of postpartum depression and its association with antenatal psychiatric symptoms: a longitudinal study. Indian J Psychol Med. 2022;44(1):37-44. DOI: https://doi.org/10.1177/0253717621991061
Maharajan S, Ramkumar DS, Amthul N. Prevalence of postpartum depression among postnatal women using EPDS. Int J Res Pharm Sci. 2021;12(3):2395-9. DOI: https://doi.org/10.26452/ijrps.v12i4.4875
Jija D. Factors associated with postnatal depression among primi mothers. Indian J Psychiatr Nurs. 2019;16(2):67-71. DOI: https://doi.org/10.4103/IOPN.IOPN_28_19
Vilarim M, Rebelo F, Vieira I, Silva AA, Leite IC, Theme Filha MM, et al. Prevalence of postpartum depression symptoms during COVID-19 pandemic: a systematic review and meta-analysis. Braz J Psychiatry. 2024;46(4):1-10. DOI: https://doi.org/10.18332/popmed/165297
Slomian J, Honvo G, Emonts P, Reginster JY, Bruyère O. Consequences of maternal postpartum depression: a systematic review. Womens Health (Lond). 2019;15:1745506519844044. DOI: https://doi.org/10.1177/1745506519844044
Vliegen N, Casalin S, Luyten P. The course of postpartum depression: a review. Harv Rev Psychiatry. 2016;22(1):1-22.
Wang Z, Liu J, Shuai H, Cai Z, Fu X, Liu Y, et al. Mapping global prevalence of depression among postpartum women. Transl Psychiatry. 2021;11(1):543. DOI: https://doi.org/10.1038/s41398-021-01692-1
Fisher J, de Mello MC, Patel V, Rahman A, Tran T, Holton S, et al. Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries. Bull World Health Organ. 2012;90(2):139-49. DOI: https://doi.org/10.2471/BLT.11.091850
Galletta MA, Hashimoto AS, de Almeida Estrambk G, Verardo IP, Cantagalli MH, Peres SV, et al. Prevalence of postpartum depression in the COVID-19 pandemic and associated factors: systematic review and meta-analysis. BMC Pregnancy and Childbirth. 2026. DOI: https://doi.org/10.1186/s12884-025-08262-z
Forty L, Jones L, Macgregor S, Caesar S, Cooper C, Hough A, et al. Familiality of postpartum depression in unipolar disorder. Am J Psychiatry. 2006;163(9):1549-53. DOI: https://doi.org/10.1176/ajp.2006.163.9.1549
Murphy-Eberenz K, Zandi PP, March D, Crowe RR, Scheftner WA, Coryell W, et al. Is perinatal depression familial? J Affect Disord. 2006;90(1):49-55. DOI: https://doi.org/10.1016/j.jad.2005.10.006
Guintivano J, Sullivan PF, Stuebe AM, Penders T, Thorp J, Rubinow DR, et al. Adverse life events and predictors of postpartum depression. Psychol Med. 2018;48(7):1190-200. DOI: https://doi.org/10.1017/S0033291717002641
Hutchens BF, Kearney J. Risk factors for postpartum depression: an umbrella review. J Midwifery Womens Health. 2020;65(1):96-108. DOI: https://doi.org/10.1111/jmwh.13067
Lara-Cinisomo S, Wood J, Fujimoto EM. Cultural orientation and perinatal depression in Latina women. Arch Womens Ment Health. 2019;22(5):557-67. DOI: https://doi.org/10.1007/s00737-018-0920-4
Glynn LM, Davis EP, Sandman CA. New insights into the role of perinatal HPA-axis dysregulation in postpartum depression. Neuropeptides. 2013;47(6):363-70. DOI: https://doi.org/10.1016/j.npep.2013.10.007
Licheri V, Talani G, Gorule AA, Biggio F, Sanna E, Biggio G. Plasticity of GABAA receptors during pregnancy and the postpartum period. Neural Plast. 2015;2015:1-12. DOI: https://doi.org/10.1155/2015/170435
Carlson K, Mughal S, Azhar Y, Siddiqui W. Postpartum depression. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2024.
Zhao XH, Zhang ZH. Risk factors for postpartum depression: an evidence-based review of systematic reviews. Asian J Psychiatr. 2020;53:102353. DOI: https://doi.org/10.1016/j.ajp.2020.102353
Azami M, Badfar G, Khalighi Z, Abbasalizadeh F, Hasani M, Talebi M, et al. Association between anemia and postpartum depression: a systematic review and meta-analysis. Caspian J Intern Med. 2019;10(2):115-24.
Arafa A, Dong JY. Gestational diabetes and risk of postpartum depressive symptoms: a meta-analysis. J Affect Disord. 2019;253:312-6. DOI: https://doi.org/10.1016/j.jad.2019.05.001
Steinig J, Nagl M, Linde K, Zietlow AL, Kersting A, Wagner B, et al. Antenatal and postnatal depression in women with obesity: a systematic review. Arch Womens Ment Health. 2017;20(4):569-85. DOI: https://doi.org/10.1007/s00737-017-0739-4
Ghaedrahmati M, Kazemi A, Kheirabadi G, Ebrahimi A, Bahrami M. Postpartum depression risk factors: a narrative review. J Educ Health Promot. 2017;6:60. DOI: https://doi.org/10.4103/jehp.jehp_9_16
Meltzer-Brody S, Kanes SJ. Allopregnanolone in postpartum depression. Neurobiol Stress. 2020;12:100213. DOI: https://doi.org/10.1016/j.ynstr.2020.100212
Douma SL, Husband C, O’Donnell ME, Barwin BN, Woodend AK. Estrogen-related mood disorders. ANS Adv Nurs Sci. 2005;28(4):364-75. DOI: https://doi.org/10.1097/00012272-200510000-00008
Nandam LS, Brazel M, Zhou M, Jhaveri DJ. Cortisol and major depressive disorder. Front Psychiatry. 2020;10:974. DOI: https://doi.org/10.3389/fpsyt.2019.00974
Dunkel Schetter C. Psychological science on pregnancy. Annu Rev Psychol. 2011;62:531-58. DOI: https://doi.org/10.1146/annurev.psych.031809.130727
Helpman L. Stress, sex, and gender in mental disorders. Neurosci Biobehav Rev. 2023;150:105190. DOI: https://doi.org/10.1016/j.neubiorev.2023.105211
Hahn-Holbrook J, Haselton M. Is postpartum depression a disease of modern civilization? Curr Dir Psychol Sci. 2014;23(6):395-400. DOI: https://doi.org/10.1177/0963721414547736
Liu H, Zhang Y, Gao Y, Zhang Z. Inflammatory markers and postpartum depression. Psychiatry Res. 2016;243:43-8. DOI: https://doi.org/10.1016/j.psychres.2016.02.022
Scottish Intercollegiate Guidelines Network. Management of perinatal mood disorders. Edinburgh: SIGN. 2012. Available at: https://www. sign.ac.uk/assets/sign127_update.pdf. Accessed on 10 February 2026.
Suryawanshi IV, Pajai S. A comprehensive review on postpartum depression. Cureus. 2022;14(12):e32855. DOI: https://doi.org/10.7759/cureus.32745
Kendall-Tackett KA. Screening for Perinatal Depression: Barriers, Guidelines, and Measurement Scales. J Clin Med. 2024;13(21):6511. DOI: https://doi.org/10.3390/jcm13216511
Magalhães PV, Pinheiro RT, Horta BL, Tomasi E, Amaral OB, Da Silva RA. Validity of the Beck Depression Inventory postpartum. Int J Psychiatry Clin Pract. 2008;12(1):81-4. DOI: https://doi.org/10.1080/13651500701330775
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56-62. DOI: https://doi.org/10.1136/jnnp.23.1.56
Sidebottom AC, Harrison PA, Godecker A, Kim H. PHQ-9 validation for prenatal depression. Arch Womens Ment Health. 2012;15(5):367-74. DOI: https://doi.org/10.1007/s00737-012-0295-x
Wisner KL, Parry BL, Piontek CM. Clinical practice. Postpartum depression. N Engl J Med. 2002;347(3):194-9. DOI: https://doi.org/10.1056/NEJMcp011542
Bayrampour H, Kapoor A, Bunka M, Ryan D. Risk of relapse after antidepressant discontinuation. J Clin Psychiatry. 2020;81(4):13134. DOI: https://doi.org/10.4088/JCP.19r13134
Li S, Zhou W, Li P, Lin R. Ketamine for preventing postpartum depression. J Affect Disord. 2024;351:720-8. DOI: https://doi.org/10.1016/j.jad.2024.01.202
Dominiak M, Antosik-Wojcinska AZ, Baron M, Włodarczyk A, Ferensztajn-Rochowiak E, Rybakowski JK. Prevention and treatment of postpartum depression. Ginekol Pol. 2021;92(2):153-64. DOI: https://doi.org/10.5603/GP.a2020.0141
Wang X, Qiu Q, Shen Z, Huang X, Zhang Y, Liu L, et al. Interpersonal psychotherapy for postpartum depression. J Affect Disord. 2023;339:823-31. DOI: https://doi.org/10.1016/j.jad.2023.07.067
Roman M, Constantin T, Bostan CM. Online CBT for postpartum depression. Women Health. 2020;60(1):99-112. DOI: https://doi.org/10.1080/03630242.2019.1610824
Rönnqvist I, Brus O, Hammar Å, Landén M, Lundberg J, Nordenskjöld A, et al. ECT in postpartum depression. J ECT. 2019;35(4):264-71.
Bashiri H, Houwing DJ, Homberg JR, Salari AA. Fluoxetine and postpartum stress. Sci Rep. 2021;11(1):8518. DOI: https://doi.org/10.1038/s41598-021-87800-z
Thour A, Marwaha R. Amitriptyline. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2023.
Sharma R, Bansal P, Saini L, Gupta R, Kaur H, Arora S. Zuranolone in postpartum depression. Pharmacol Biochem Behav. 2024;238:173734. DOI: https://doi.org/10.1016/j.pbb.2024.173734
Thomson M, Sharma V. Therapeutics of postpartum depression. Expert Rev Neurother. 2017;17(5):495-507. DOI: https://doi.org/10.1080/14737175.2017.1265888
Ronnqvist I, Brus O, Hammar A, Landen M, Lundberg J, Nordenskjold A, et al. ECT in postpartum depression. J ECT. 2019;35(4):264-71. DOI: https://doi.org/10.1097/YCT.0000000000000578
Vliegen N, Casalin S, Luyten P. Course of postpartum depression. Harv Rev Psychiatr. 2016;22(1):1-22. DOI: https://doi.org/10.1097/HRP.0000000000000013
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