Cited by 1,055Maternal Mental Health During Pregnancy and PostpartumMaternal and Neonatal HealthcareMaternal and Perinatal Health Interventions

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Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis

Shorey, Shefaly, Chee, Cornelia Yin Ing, Ng, Esperanza Debby, Chan, Yiong Huak, Tam, Wilson Wai San, Chong, Yap Seng·2018·Journal of Psychiatric Research

DOI 10.1016/j.jpsychires.2018.08.001

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Abstract

This review aims to examine the prevalence and incidence of postpartum depression among healthy mothers without prior history of depression including postpartum depression and who gave birth to healthy full-term infants. A systematic search of ClinicalTrials.gov, CINAHL, EMBASE, PsycINFO, and PubMed was performed for English articles from the inception of the database to November 2017, as well as a manual search of the reference lists of the included articles, and an expert panel was consulted. Across 15,895 articles, 58 articles (N = 37,294 women) were included in the review. The incidence of postpartum depression was 12% [95% CI 0.04-0.20] while the overall prevalence of depression was 17% [95% CI 0.15-0.20] among healthy mothers without a prior history of depression. Prevalence was similar regardless of the type of diagnostic tool used; however, there were statistical differences in the prevalence between different geographical regions, with the Middle-East having the highest prevalence (26%, 95% CI 0.13-0.39) and Europe having the lowest (8%, 95% CI 0.05-0.11). There was no statistical difference in prevalence between different screening time points, but an increasing prevalence was observed beyond six months postpartum. Intervention studies often neglect healthy mothers. This review reports a similar prevalence rate of postpartum depression among mothers without history of depression when compared to mothers with history of depression. Thus, future studies should place equal emphasis on this neglected group of mothers so that targeted interventions and follow-ups can be introduced at appropriate time points.

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Predictors of postnatal depression in the slums Nairobi, Kenya: a cross-sectional study
Kariuki, E., Kuria, M. W., Were, F., & Ndetei, D. M. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-03885-4 · Cited by 28
“Comparable to our finding, a systematic review and meta-analysis revealed a prevalence rate of 26% in Middle-East countries, while European countries had lower rates (8%) [38].”
Result
Fear and anxiety related to COVID-19 pandemic may predispose to perinatal depression in Italy
Orsolini, L., Pompili, S., Mauro, A., Salvi, V., & Volpe, U. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.977681 · Cited by 24
Exploration for biomarkers of postpartum depression based on metabolomics: A systematic review
Li, S., Yang, Z., Yao, M., Shen, Y., Zhu, H., Jiang, Y., Ji, Y., & Yin, J. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.08.043 · Cited by 23
A systematic review of interpersonal psychotherapy for postpartum depression
Wang, X., Qiu, Q.-M., Shen, Z., Yang, S., & Shen, X. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.07.067 · Cited by 29
Long-Term Effects of Maternal Depression during Postpartum and Early Parenthood Period on Child Socioemotional Development
Suarez, A., Shraibman, L., & Анатольевна, Я. В. (2023) · Children · doi:10.3390/children10101718 · Cited by 23
“Maternal depressive symptoms during pregnancy and the ﬁrst year of postnatal life are highly prevalent, with some studies indicating their levels as being up to 7–20% among pregnant women [9] and as high as 10–26% during the postpartum period [10].”
Background
Novel Meta Learning Approach for Detecting Postpartum Depression Disorder Using Questionnaire Data
Nasim, S., Al‐Shamayleh, A. S., Thalji, N. J., Raza, A., Abualigah, L., Alzahrani, A. I., Alwadain, A. S., Alsekait, D. M., Migdady, H., & AbdElminaam, D. S. (2024) · IEEE Access · doi:10.1109/access.2024.3427685 · Cited by 23
“According to a study, between the years 2013 and 2018, its prevalence rose from 13% to 17% [5].”
Background
Early detection of mental illness for women suffering high-risk pregnancies: an explorative study on self-perceived burden during pregnancy and early postpartum depressive symptoms among Chinese women hospitalized with threatened preterm labour
Ni, Q., Cheng, G., Chen, A., & Heinonen, S. T. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02667-0 · Cited by 23
Postpartum depression in women with maternal near miss: a systematic review and meta-analysis
Abdollahpour, S., Heydari, A., Ebrahimipour, H., Faridhoseini, F., Miri, H. H., & Khadivzadeh, T. (2021) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2021.1885024 · Cited by 23
“With an glance overview of other systematic review among healthy mothers studies that have examined rates of PPD realize that the consolidated prevalence of PPD is in Turkey 24% [27], in Southern Brazil 14% [28], in the Middle-East 26%, Europe 8% [9] and in India 19% [29].”
Background
Brief cognitive behavioral therapy in pregnant women at risk of postpartum depression: Pre-post therapy study in a city in southern Brazil
Pinheiro, R. T., Trettim, J. P., de Matos, M. B., Pinheiro, K. A. T., da Silva, R. A., Martins, C. D. S. R., da Cunha, G. K., Coelho, F. T., Motta, J. V. D. S., Coelho, F. M. D. C., et al. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.04.031 · Cited by 23
“The incidence of postpartum depression (PPD) is 12% (Shorey et al., 2018).”
Background
Effectiveness of psychological interventions in preventing postpartum depression in non-depressed women: a systematic review and meta-analysis of randomized controlled trials
Gómez, C. M., Moreno-Peral, P., Bellón, J. Á., Cerón, S. C., Campos-Paíno, H., Gómez‐Gómez, I., Rigabert, A., Benítez, I., & Motrico, E. (2022) · Psychological Medicine · doi:10.1017/s0033291722000071 · Cited by 26
“Introduction Postpartum depression (PPD) is one of the most common disorders following childbirth (Rasmussen, Strøm, Wohlfahrt, Videbech, & Melbye, 2017) with a global prevalence of 17% and an incidence of 12% (Hahn-Holbrook, Cornwell-Hinrichs, & Anaya, 2018; Shorey et al., 2018).”
Background
Digital screening for postnatal depression: mixed methods proof-of-concept study
Eisner, E., Lewis, S. W., Stockton-Powdrell, C., Agass, R., Whelan, P., & Tower, C. L. (2022) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-022-04756-2 · Cited by 26
Effectiveness of the “Essential Coaching for Every Mother” postpartum text message program on maternal psychosocial outcomes: A randomized controlled trial
Dol, J., Aston, M. L., Grant, A. K., McMillan, D., Murphy, G. T., & Campbell-Yeo, M. L. (2022) · Digital Health · doi:10.1177/20552076221107886 · Cited by 21
“It is important to note that between 15% and 25% of participants had a high probability of depression at either baseline or sixweeks postpartum, consistent with population norms.(12) This suggests that postpartum depression is a concern in this population and additional supports may be needed to specifically target po…”
Result
Childbirth Pain, Labor Epidural Analgesia, and Postpartum Depression: Recent Evidence and Future Directions
Du, W., Bo, L., Xu, Z., & Liu, Z. (2022) · Journal of Pain Research · doi:10.2147/jpr.s379580 · Cited by 27
“Introduction Postpartum depression (PPD), defined as an episode of major depression after childbirth, affects 12–17% of women worldwide.(1,2) Over the past two decades, the prevalence of PPD among Chinese women has been estimated to range from 4.”
Background
Activation of σ-1 receptor mitigates estrogen withdrawal-induced anxiety/depressive-like behavior in mice via restoration of GABA/glutamate signaling and neuroplasticity in the hippocampus
Ren, P., Wang, J.-Y., Chen, H., Wang, Y., Cui, L.-Y., Duan, J.-Y., Guo, W.-Z., Zhao, Y., & Li, Y. (2024) · Journal of Pharmacological Sciences · doi:10.1016/j.jphs.2024.02.003 · Cited by 23
From Breastfeeding to Support in Mothers’ Feeding Choices: A Key Role in the Prevention of Postpartum Depression?
Dessì, A., Pianese, G., Mureddu, P., Fanos, V., & Bosco, A. (2024) · Nutrients · doi:10.3390/nu16142285 · Cited by 32
“This review analyzed a specific group of healthy mothers who gave birth to healthy children with no history of mental illness, including PPD, showing similar levels of PPD prevalence compared to mothers with a history of psychiatric illness [36].”
Result
Comparing the prevalence and influencing factors of postpartum depression in primiparous and multiparous women in China
Zhang, J., Wang, P., Fan, W., & Lin, C. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1479427 · Cited by 32
Validation of the intolerance of uncertainty scale as a screening tool for perinatal anxiety
Furtado, M., Frey, B. N., & Green, S. M. (2021) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-021-04296-1 · Cited by 22
“Until recently, perinatal mental health research has focused on postpartum depression (PPD) which affects as many as 12% of women [6], however, there has been increasing awareness that the perinatal period is also associated with high risk for anxiety disorders.”
Background
Association between pre-pregnancy tobacco smoking and postpartum depression: A nationwide cohort study
Yook, V., Yoo, J., Han, K., D, M. F. M., Mischoulon, D., Park, M. J., Kim, H., & Jeon, H. J. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.07.065 · Cited by 22
Are “Superwomen” without social support at risk for postpartum depression and anxiety?
Arnold, M. S., & Kalibatseva, Z. (2020) · Women & Health · doi:10.1080/03630242.2020.1844360 · Cited by 28
Postpartum Depression: A Metaphorical Analysis
Beck, C. T. (2020) · Journal of the American Psychiatric Nurses Association · doi:10.1177/1078390320959448 · Cited by 21
“In a meta-analysis of 58 studies, Shorey et al. (2018) reported that the incidence of postpartum depression in healthy mothers without prior history of depression was 12% and the prevalence was 17%.”
Background
Maternal perinatal anxiety and neural responding to infant affective signals: Insights, challenges, and a road map for neuroimaging research
Yatziv, T., Vancor, E. A., Bunderson, M., & Rutherford, H. J. V. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.09.043 · Cited by 21
Paternal prevalence and risk factors for comorbid depression and anxiety across the first 2 years postpartum: A nationwide Canadian cohort study
Dennis, C., Marini, F., Dol, J., Vigod, S., Grigoriadis, S., & Brown, H. (2021) · Depression and Anxiety · doi:10.1002/da.23234 · Cited by 18
The Efficacy of Digital Cognitive–Behavioral Interventions in Supporting the Psychological Adjustment and Sleep Quality of Pregnant Women with Sub-Clinical Symptoms: A Systematic Review and Meta-Analysis
Mancinelli, E., Bassi, G., Gabrielli, S., & Salcuni, S. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19159549 · Cited by 21
“Indeed, depression, anxiety, and stress symptoms, beyond being highly interrelated [11–14], are all quite prevalent during pregnancy (depression: 15–65% [15]; anxiety: 18–24% [16]; stress: low–moderate 78% [17]), as well as during the postpartum period (depression: around 17% [18]; anxiety: around 15% [16]; stress: 20…”
Background
Postpartum depression and its correlates: a cross-sectional study in southeast Iran
Zakeri, M. A., Khoram, S., Bazmandegan, G., Ghaedi‐Heidari, F., Talebi, B., Ramezani, N., Ahmadi, F., Kamiab, Z., & Dehghan, M. (2022) · BMC Women s Health · doi:10.1186/s12905-022-01978-6 · Cited by 21
The association between epidural labour analgesia and postpartum depression: a randomised controlled trial
Tan, H. S., Tan, C. W., Sultana, R., Chen, H. Y., Chua, T., Rahman, N., Gandhi, M., Sia, A. T. H., & Sng, B. L. (2023) · Anaesthesia · doi:10.1111/anae.16178 · Cited by 21
Levels of n-3 and n-6 Fatty Acids in Maternal Erythrocytes during Pregnancy and in Human Milk and Its Association with Perinatal Mental Health
Urech, C., Eussen, S. R. B. M., Alder, J., Stahl, B., Boehm, G., Bitzer, J., Bartke, N., & Hoesli, I. M. (2020) · Nutrients · doi:10.3390/nu12092773 · Cited by 24
Reciprocal Influence of Depressive Symptoms Between Mothers and Fathers During the First Postpartum Year: A Comparison Among Full-Term, Very Low, and Extremely Low Birth Weight Infants
Neri, E., Giovagnoli, S., Genova, F., Benassi, M., Stella, M., & Agostini, F. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.578264 · Cited by 23
Risk Factors in Postpartum Depression Among Women from South-East of Romania: Importance of Early Diagnosis
Izvoranu, S., Banariu, G. M., Chirila, S. I., Nour, C., Niculescu, C., Rus, M., Badiu, D. L., Delcea, C., & Tica, V. (2024) · Archives of Pharmacy Practice · doi:10.51847/0omtmeujbe · Cited by 20
Anxiety, stress, and depression levels among dental students: gender, age, and stage of dental education related
Lugassy, D., Ben-Izhack, G., Zissu, S., Lahav, R. S., Rosner, O., Elzami, R., Shely, A., & Naishlos, S. (2025) · Psychology Health & Medicine · doi:10.1080/13548506.2025.2476085 · Cited by 20
“These women encounter social and economic problems due to unemployment because of high clinical and academic requirements which led to low access to health services despite their greater needs (Bryson et al., 2021; Redshaw & Henderson, 2016; Shorey et al., 2018).”
The association between labour epidural analgesia and postpartum depressive symptoms: a longitudinal cohort study
Munro, A., George, R. B., Mackinnon, S. P., & Rosen, N. O. (2021) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/s12630-020-01900-4 · Cited by 22
“Defined as major depression beginning within four weeks of giving birth,(5) clinical studies estimate the prevalence of PPD is approximately 17% among mothers without a prior history of depression.(6)”
Background
Bibliometrics and Visual Analysis of the Research Status and Trends of Postpartum Depression From 2000 to 2020
Bai, X., Song, Z., Zhou, Y., Wang, X.-X., Wang, Y., & Zhang, D. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.665181 · Cited by 22
“The internationally recognized prevalence of PPD was 10–15% (Shorey et al., 2018).”
Background
Subjective Birth Experience Predicts Mother–Infant Bonding Difficulties in Women With Mental Disorders
Junge-Hoffmeister, J., Bittner, A., Garthus-Niegel, S., Goeckenjan, M., Martini, J., & Weidner, K. (2022) · Frontiers in Global Women's Health · doi:10.3389/fgwh.2022.812055 · Cited by 15
“In addition, other potentially trauma-related postpartum disorders are common in early motherhood with prevalence rates ranging from 10 to 20% for depression and 10% for postpartum anxiety disorders, depending on definition, time frame, and population (22).”
Background
Ketamine as Potential Treatment for Postpartum Depression: A Narrative Review
Chen-Li, D. C. J., Lui, L. M. W., Rosenblat, J. D., Lipsitz, O., Teopiz, K. M., Ho, R., Vinberg, M., Golts, M., Jawad, M. Y., Lee, Y. L., et al. (2022) · Annals of Clinical Psychiatry · doi:10.12788/acp.0082 · Cited by 20
Antenatal depression across trimesters as a risk for postpartum depression and estimation of the fraction of postpartum depression attributable to antenatal depression: A systematic review and meta-analysis of cohort studies
Dlamini, L. P., Amelia, V. L., Shongwe, M. C., Chang, P., & Chung, M. (2023) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2023.09.005 · Cited by 22
The impact of postpartum depression on infant development in the first year of life
Alfayumi‐Zeadna, S., Masarwe, S., Findling, Y., Ereli, A., & O’Rourke, N. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119558 · Cited by 21
Maternal fluoxetine reduces hippocampal inflammation and neurogenesis in adult offspring with sex-specific effects of periadolescent oxytocin
Qiu, W., Go, K. A., Wen, Y., Duarte‐Guterman, P., Eid, R. S., & Galea, L. A. M. (2021) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2021.06.012 · Cited by 19
Prevalence and risk factors of maternal depression among women who participated in a home visitation program in South Korea
Kang, S. Y., Khang, Y., June, K. J., Cho, S.-H., Lee, J. Y., Kim, Y., & Cho, H. (2022) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-022-02226-w · Cited by 19
“6 times higher than those evaluated by diagnostic instruments [12], whereas another study reported that the prevalence of depression was similar regardless of the type of diagnostic tool used [25].”
BackgroundResult
Predictors of postpartum depression and the utilization of postpartum depression services in rural areas in the Philippines
Labrague, L. J., McEnroe–Petitte, D. M., Tsaras, K., Yboa, B. C., Rosales, R. A., Tizon, M. M., & D’Souza, M. S. (2019) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12428 · Cited by 21
Randomized controlled trial of Sunnyside: individual versus group-based online interventions to prevent postpartum depression
Duffecy, J., Grekin, R., Long, J. D., Mills, J. A., & O'Hara, M. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.05.123 · Cited by 19
Postnatal Depression Beyond 12 Months: A Systematic Review and Meta‐Analysis
Hellyer, E., Nash, K., Jones, E., Sitch, A. J., Janković, J., Berrisford, G. S., Casey, A., & MacArthur, C. (2025) · International Journal of Mental Health Nursing · doi:10.1111/inm.70018 · Cited by 20
“…have been several systematic reviews of PND only during the first postpartum year, the most recent in 2021, which reported a prevalence of 17.2 (95% CI 16.0–18.5) ( Wang et al. 2021), similar to earlier review estimates of 13%–19.2% (Shorey et al. 2018) (Gavin et al. 2011; O'Hara and Swain 1996).”
Influential
Associations between Coparenting Relationships and Maternal Depressive Symptoms and Negative Bonding to Infant
Takeishi, Y., Nakamura, Y., Yoshida, M., Kawajiri, M., Atogami, F., & Yoshizawa, T. (2021) · Healthcare · doi:10.3390/healthcare9040375 · Cited by 18

Authors: Shorey, S., Chee, C. Y. I., Ng, E. D., Chan, Y. H., Tam, W. W. S., & Chong, Y. S.
Affiliations: National University of Singapore (SG)
National University Hospital (SG)
Corresponding author: Shorey, Shefaly
ORCID: Shorey, Shefaly
Chee, Cornelia Yin Ing
Ng, Esperanza Debby
Chan, Yiong Huak
Tam, Wilson Wai San
Chong, Yap Seng
Venue: Journal of Psychiatric Research
Publisher: Elsevier BV
Published: 2018-09
Volume: 104
Pages: 235-248
ISSN: 0022-3956 (ISSN-L)
DOI: 10.1016/j.jpsychires.2018.08.001
OpenAlex: W2885511794
Cited by: 1,055
References: 106
Citations by year: 2026: 127 · 2025: 160 · 2024: 181 · 2023: 175 · 2022: 166 · 2021: 136 · 2020: 76 · 2019: 28 · 2018: 4
FWCI: 11.06
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Psychiatric Research (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
Keywords: postpartum depression, prevalence, incidence, term infants, postpartum screening, diagnostic tools, regional variation, postpartum period
MeSH terms: Female, Humans, Mothers, Incidence, Prevalence, Databases, Factual, Depression, Postpartum

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Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis

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