Prevalence and Risk Factors of Postpartum Depression in Women: A Systematic Review and Meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational cohort and case-control studies
PubMed 34750904 · doi:10.1111/jocn.16121
What was done
A systematic review and meta-analysis of cohort and case-control studies identified via Cochrane Library, PubMed, Embase, and Web of Science up to December 31, 2020. Random-effects models were used to synthesize the pooled prevalence of postpartum depression (PPD) and calculate odds ratios for associated risk factors.
What was found
Across 33 evaluated citations, 27 reported PPD prevalence in 33 study populations totaling 133,313 participants. - **Pooled prevalence:** 14.0% (95% CI, 12.0%–15.0%), varying by country from 5.0% to 26.32%. - **Associated factors:** - Gestational diabetes mellitus: OR = 2.71 (95% CI, 1.78–4.14; I² = 0.0%) - Depression during pregnancy: OR = 2.40 (95% CI, 1.96–2.93; I² = 96.7%) - History of depression during pregnancy: OR = 4.82 (95% CI, 1.32–17.54; I² = 74.9%) - History of depression: OR = 3.09 (95% CI, 1.62–5.93; I² = 86.5%) - Giving birth to a boy: OR = 1.62 (95% CI, 1.28–2.05; I² = 0.0%) - Epidural anaesthesia during delivery: OR = 0.81 (95% CI, 0.13–4.87; I² = 90.1%)
Why it matters
This study quantifies the substantial global burden of PPD (affecting approximately 1 in 7 women) and highlights clinical history and perinatal variables that may guide targeted screening protocols.
Limits
All included designs were observational (cohort and case-control), precluding causal inference. Substantial statistical heterogeneity affected several risk factors (I² exceeding 70% to 96% for depression-related variables). For epidural anaesthesia, the confidence interval was very wide and crossed unity (OR = 0.81, 95% CI, 0.13–4.87), making its classification as an established risk factor statistically unsupported.
Cited by
- supports A history of anxiety, PTSD, depression, or premenstrual dysphoric disorder increases the risk of developing postpartum depression.