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Biological and Psychosocial Predictors of Postpartum Depression: Systematic Review and Call for Integration
Open accessAbstract
Postpartum depression (PPD) adversely affects the health and well being of many new mothers, their infants, and their families. A comprehensive understanding of biopsychosocial precursors to PPD is needed to solidify the current evidence base for best practices in translation. We conducted a systematic review of research published from 2000 through 2013 on biological and psychosocial factors associated with PPD and postpartum depressive symptoms. Two hundred fourteen publications based on 199 investigations of 151,651 women in the first postpartum year met inclusion criteria. The biological and psychosocial literatures are largely distinct, and few studies provide integrative analyses. The strongest PPD risk predictors among biological processes are hypothalamic-pituitary-adrenal dysregulation, inflammatory processes, and genetic vulnerabilities. Among psychosocial factors, the strongest predictors are severe life events, some forms of chronic strain, relationship quality, and support from partner and mother. Fully integrated biopsychosocial investigations with large samples are needed to advance our knowledge of PPD etiology.
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“Psychosocial stressors such as lack of support, prior psychiatric history, and negative childbirth experiences further increase the risk of developing PPD.11”
From Influence of Neuraxial Anesthesia Technique During Vaginal and Cesarean Delivery and Association with Postpartum Depression: A Narrative Review of Literature (2026) · cites this paper as [11]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Importantly, confounding variables from unmeasured psychosocial variables, such as partner support, socioeconomic stress, prior trauma, and access to mental health care may influence reported associations.11”
From Influence of Neuraxial Anesthesia Technique During Vaginal and Cesarean Delivery and Association with Postpartum Depression: A Narrative Review of Literature (2026) · cites this paper as [11]
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In the citing paper
“The development of PPD is multifactorial, influenced by biological, psychological, and social determinants.11,12”
In the citing paper
“Likewise, although animal studies have documented complex neurobiological modifications associated with the mammalian transition to parenthood (Lambert, 2012), biological factors have yet to be properly integrated within psychosocial studies of distress in the perinatal period (Yim, Tanner Stapleton, Guardino, Hahn-Holbrook, & Dunkel Schetter, 2015).”
From Couples becoming parents: Trajectories for psychological distress and buffering effects of social support (2020) · cites this paper as Yim, Tanner Stapleton, Guardino, Hahn-Holbrook, & Dunkel Schetter, 2015
In the citing paper
“our anxious-depressive symptoms latent factor encompassed scores on three standardized measures (i.e., CESD, STAI and GHQ) and was supplemented by prenatal assessments of both maternal and paternal cortisol (Yim et al., 2015).”
From Couples becoming parents: Trajectories for psychological distress and buffering effects of social support (2020) · cites this paper as Yim et al., 2015
In the citing paper
“most studies tend to investigate the contribution of only one or two risk factors altogether (e.g., Hetherington, McDonald, Williamson, Patten and Tough, 2018 [14]), so the communalities between biopsychosocial factors are not controlled and the unique contribution of each variable remains unclear [15].”
From Predicting Postpartum Depressive Symptoms from Pregnancy Biopsychosocial Factors: A Longitudinal Investigation Using Structural Equation Modeling (2020) · cites this paper as [15]
In the citing paper
“For example, biological factors, such as reproductive and stress hormones, psychological variables, such as beliefs and perceived anxiety control, social factors such as marital satisfaction and peer support, and contextual information (i.e., seasonal time frame or seasonal light exposure), have also been linked with depressive symptomatology in perinatal research [15,61], but were not included in”
From Predicting Postpartum Depressive Symptoms from Pregnancy Biopsychosocial Factors: A Longitudinal Investigation Using Structural Equation Modeling (2020) · cites this paper as [15]
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Hessami, K., Romanelli, C., Chiurazzi, M., & Cozzolino, M. (2022) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2020.1843155 · Cited by 384
Metadata
- Authors
- Yim, I. S., Tanner Stapleton, L. R., Guardino, C. M., Hahn-Holbrook, J., & Dunkel Schetter, C.
- Affiliations
- University of California, Irvine (US)
- Department of Psychology, University of California, Los Angeles, California 90095;, ,
- University of California, Los Angeles (US)
- Corresponding author
- Yim, Ilona S.
- Venue
- Annual Review of Clinical Psychology
- Publisher
- Annual Reviews
- Published
- 2015-03-28
- Volume
- 11
- Issue
- 1
- Pages
- 99-137
- ISSN
- 1548-5943 (ISSN-L)
- 1548-5951
- PMC
- PMC5659274
- OpenAlex
- W2098303391
- Cited by
- 749
- References
- 236
- Citations by year
- 2026: 74 · 2025: 86 · 2024: 64 · 2023: 91 · 2022: 79 · 2021: 87 · 2020: 107 · 2019: 73 · 2018: 37 · 2017: 21 · 2016: 22 · 2015: 8
- FWCI
- 4.23
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Annual Review of Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Mental Health (15750, NIMH T32, MH T32 15750, T32MH015750)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy-related medical research
- Keywords
- postpartum depression, biopsychosocial model, risk factors, inflammation, genetic susceptibility, psychosocial factors, life events, chronic strain, relationship quality, social support, postpartum depressive symptoms, etiology
- MeSH terms
- Endocrine System Diseases, Female, Humans, Pregnancy, Psychology, Risk Factors, Depression, Postpartum
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