Within the first year of childbirth, postpartum depression (PPD) affects about 1 in 6 women worldwide.¹ According to the Centers for Disease Control and Prevention (CDC), the rate of PPD was seven times higher in 2015 than in 2000.² This trend was also seen across different races from 2010 to 2021, as the prevalence of PPD increased from 13.5% to 21.8% for White women, 8.9% to 18.8% for Hispanic women, and 9.2% to 22.0% for Black women.³

Even though PPD is considered a subcategory of major depressive disorder (MDD), PPD has distinguishable features and requires a customized treatment plan.⁴ For example, PPD symptoms bring additional concerns, such as difficulty dealing with caring for a new baby, which can heighten maternal guilt and shame. Additionally, the presentation of symptoms in PPD varies depending on the timing of depression onset within the postpartum period.⁴ For example, women with depression onset within 8 weeks postpartum are more likely to experience anxious anhedonia compared to women who experience onset during pregnancy (prenatal onset).⁴ This unique symptom presentation impacts the maternal burden, the newborn, and family interactions. In this way, untreated PPD can reach beyond the mother to negatively affect the entire family.

Devastating Consequences of Untreated PPD

Effects on Mothers

Recent studies show that women with PPD experienced lower self-esteem, higher levels of anger, and lower levels of reaction to harmful stimuli than mothers without PPD.⁵ One of the irreversible consequences of untreated PPD is suicide, with 13% to 36% of maternal deaths being attributed to suicide.⁶ Additionally, 3% to 19% of women who suffer from postnatal depression experience suicidal ideation. Women are at the highest risk of suicide during the first year after birth, and that risk remains elevated even 18 years after giving birth.⁷

Effects on the Newborn

Untreated PPD can have detrimental effects on care for the newborn. Mothers may show a reduced responsiveness to a baby’s cues, which could delay meeting the baby’s needs.⁸ Mothers may also have fewer emotional interactions with their babies, especially during times of connection like holding and hugging. Maternal PPD, therefore, impacts attachment and mother-infant bonding. These factors can ultimately affect an infant’s development.^8,9 For example, infants of mothers diagnosed with PPD typically gain less weight, may have delayed language development, and are more likely to have mood disorders and behavior problems compared to infants whose mothers are not diagnosed with PPD. Additionally, infants of mothers diagnosed with PPD may experience delays in their cognitive development.⁵

Underdiagnosis of PPD

There are opportunities for improvement in PPD care that can help patients achieve better outcomes. Treatment plans are most effective when we understand the unmet needs experienced by women and their families. One significant unmet need in PPD is a lack of regular screening. The American College of Obstetricians and Gynecologists (ACOG) recommends depression screening twice during pregnancy and at all postpartum visits.¹⁰ However, a retrospective study showed that screening rates vary widely.¹⁰ Unfortunately, only about 65% of women in the US are successfully screened, and screening rates are heterogeneous worldwide. Moreover, women who are non-White, who are insured by Medicare or Medicaid, and who do not speak English are less likely to be screened, even though they are often at higher risk of presenting with PPD.¹⁰

Furthermore, some women remain undiagnosed due to persistent stigma. Often, women report feelings of shame and guilt associated with their symptoms. Even if they were adequately screened and identified with suspected PPD, they may not follow up with consultation or treatment. In these cases, women may not be ready to accept a diagnosis and appropriate care.¹¹

Undertreatment of PPD

Unfortunately, receiving a diagnosis of PPD is only half the battle. Of women with a diagnosis of PPD, 75% do not receive treatment.¹² Many postpartum women do not seek treatment due to a lack of time and resources.¹³ Another reason that some women remain untreated is that they may not be aware of the current treatment options available to them. This is especially true for women without a history of mental health conditions.¹³ Some women are also unwilling to take medications because they are fearful of side effects for themselves¹³ and their babies through the transfer of the medication into breast milk.¹⁴ Additionally, cultural factors may be involved in treatment decision-making. Non-White women report being rushed during appointments, and they also report a lack of cultural awareness from their providers.

Social Needs

Social support is inversely correlated with depression and plays a significant role in reducing depression.¹⁵ Social needs include dependence on social programs for food, lack of transportation to appointments,¹⁶ inability to pay for utilities, and housing concerns.¹⁷ Social needs also include moral support from family, friends, and spouses.¹⁷ Women with any social need are more likely to test positive for PPD during screening, and they are also more likely to have thoughts of self-harm.¹⁷ In addition to PPD screening, recognizing and addressing social needs is vital for successful PPD treatment.¹⁷

Conclusion

PPD remains a significant concern for many women across the globe. To provide the best care for women, infants, and families suffering from the impact of PPD, current unmet needs must be addressed. Recognizing social needs and barriers can help drive advancements and improvements in treatment and patient outcomes.

References:

1. Wang Z, Liu J, Shuai H, et al. Mapping global prevalence of depression among postpartum women. Transl Psychiatry. 2021;11(1): 543 https://doi.org/10.1038/s41398-021-01663-6
2. Symptoms of depression among women. Centers for Disease Control and Prevention. Updated May 2024, Accessed September 18, 2024. https://www.cdc.gov/reproductive-health/depression/index.html#:~:text=Depression%20rates%20during%20and%20after,reported%20symptoms%20of%20postpartum%20depression
3. Getahun D, Oyelese Y, Peltier M, et al. Trends in postpartum depression by race/ethnicity and pre-pregnancy body mass index. Am J Obstet Gynecol. 2023;228(1):s122-s123. https://doi.org/10.1016/j.ajog.2022.11.248
4. Batt MM, Duffy KA, Novick AM, Metcalf CA, Epperson CN. Is postpartum depression different from depression occurring outside of the perinatal period? A review of the evidence. Focus. 2020;18(2):106-119. https://doi.org/10.1176/appi.focus.20190045
5. Slomian J, Honvo G, Emonts P, Reginster JY, Bruyère O. Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes. Women’s Health. 2019;15: 174550651984404. https://doi.org/10.1177/1745506519844044
6. Lommerse K, Knight M, Nair M, Deneux‐Tharaux C, van den Akker T. The impact of reclassifying suicides in pregnancy and the postnatal period on maternal mortality ratios. BJOG. 2019;126(9):1088-1092. doi:10.1111/1471-0528.15215
7. Yu H, Shen Q, Bränn E, et al. Perinatal depression and risk of suicidal behavior. JAMA Netw Open. 2024;7(1):e2350897. https://doi.org/10.1001/jamanetworkopen.2023.50897
8. Saharoy R, Potdukhe A, Wanjari M, Taksande AB. Postpartum depression and maternal care: exploring the complex effects on mothers and infants. Cureus. 2023;15(7):e41381. https://doi.org/10.7759/cureus.41381
9. Śliwerski A, Kossakowska K, Jarecka K, Świtalska J, Bielawska-Batorowicz E. The effect of maternal depression on infant attachment: a systematic review. Int J Environ Res Public Health. 2020;17(8):2675. doi:10.3390/ijerph17082675
10. Sidebottom A, Vacquier M, LaRusso E, Erickson D, Hardeman R. Perinatal depression screening practices in a large health system: Identifying current state and assessing opportunities to provide more equitable care. Arch Womens Ment Health.2020;24(1):133-144. https://doi.org/10.1007/s00737-020-01035-x
11. Manso-Córdoba S, Pickering S, Ortega MA, Asúnsolo Á, Romero D. Factors related to seeking help for postpartum depression: A secondary analysis of New York City Prams Data. Int J Environ Res and Public Health. 2020;17(24):9328. https://doi.org/10.3390/ijerph17249328
12. Moore Simas TA, Whelan A, Byatt N. Postpartum depression—new screening recommendations and treatments. JAMA. 2023;330(23): 2295-2296. https://doi.org/10.1001/jama.2023.21311
13. Iturralde E, Hsiao CA, Nkemere L, et al. Engagement in perinatal depression treatment: a qualitative study of barriers across and within racial/ethnic groups. BMC Pregnancy Childbirth. 2021;21(1):512. doi:10.1186/s12884-021-03969-1
14. Cook C, Goyal D, Allen M. Experiences of women with postpartum depression participating in a support group led by mental health providers. MCN Am J Matern Child Nurs. 2019;44(4), 228–233. https://doi.org/10.1097/nmc.0000000000000533
15. Liu W, Wu X, Gao Y, et al. A longitudinal study of perinatal depression and the risk role of cognitive fusion and perceived stress on postpartum depression. J Clin Nurs. 2023;32(5-6):799-811. doi:10.1111/jocn.16338
16. Lafferty AK, Duryea E, Martin R, et al. a prospective study of social needs associated with mental health among postpartum patients living in underserved communities. Am J Perinatol. 2024;41(S 01):e2396-e2402. doi:10.1055/a-2113-2739
17. Chavez LJ, Tyson DP, Davenport MA, Kelleher KJ, Chisolm DJ. Social needs as a risk factor for positive postpartum depression screens in pediatric primary care. Acad Pediatr. 2023;23(7):1411-1416. doi:10.1016/j.acap.2023.03.007