The prevalence of postpartum depression

Having a new baby is a life-altering experience, and many assume that it is a universally joyful one. That assumption can lead to mental health stigma for new moms who have complex and nuanced experiences after childbirth. The idea that new parents are supposed to be full of bliss is just one of the reasons that postpartum depression (PPD), also called perinatal depression, often goes undetected. 

“Postpartum depression can be especially insidious, as new parents expect to feel excited and happy about their babies,” says Alex Juusela, an OB-GYN in Detroit and Maternal-Fetal Medicine Fellow at the National Institutes of Health Perinatology Research Branch at Wayne State University / Detroit Medical Center. 

Unfortunately, symptoms of postpartum depression go untreated for the same reasons. “Postpartum depression often goes undiagnosed as patients can fear the stigma surrounding depression and hide or not report their symptoms,” Dr. Juusela explains. That’s why understanding PPD and proper screening is so important. There are effective courses of treatment for PPD available, but the cultural taboo around talking about women’s health conditions and mental health renders them unavailable to new mothers with the highest risk factors. 

What is postpartum depression?

Postpartum depression can be defined as depression that manifests within the first year after a person has been pregnant, says Gayle MacBride, Ph.D., a clinical psychologist and cofounder of telehealth provider Veritas Psychology Partners. “PPD is often triggered by significant hormonal fluctuations (estrogen/progesterone and even thyroid changes), sleep deprivation, physical stress from childbirth, lack of social support, and the challenges of adjusting to parenthood,” MacBride says. People who have experienced depression or anxiety outside the perinatal time are at an increased risk for PPD. 

Postpartum depression symptoms include extreme fatigue, mood swings, irritability, feelings of guilt or inadequacy as a parent, changes in appetite, and difficulty bonding with the baby.

The difference between postpartum depression and major depression or depressive disorder is, as Dr. Juusela explains, really a matter of timing. “The Diagnostic Statistical Manual (DSM IV) specifies that the postpartum depressive episode begins within four weeks of giving birth,” he says but adds that we know from reporting of behavioral health clinicians that PPD can appear any time in the year after a person gives birth. 

In other words, PPD can be confused with other kinds of mental illness, or it can be written off as “baby blues.” While the “baby blues” are common and mild feelings of sadness after giving birth, they generally resolve a few weeks after giving birth. PPD and postpartum mood disorders persist for longer and may have more intense symptoms.

How common is postpartum depression?

• One in 8 women in the U.S. report depression in the postpartum period. (CDC, 2018)
• 1 in 5 women experienced symptoms of PPD but did not report symptoms until asked by a healthcare provider. (Centers for Disease Control and Prevention, 2020)
• 1 in 8 women are not asked about depression during postpartum visits. (CDC, 2020)
• The prevalence of PPD has been increasing in the U.S. Race is a factor. Of women reporting PPD, 38.6% were white, 6.6% were Black, 26% were Hispanic, and 24.3% were Asian. (JAMA, 2023)
• Rates of PPD are higher for obese and morbidly obese women. (AJOG, 2023) 

Postpartum depression statistics worldwide

The World Health Organization predicts that postpartum depression affects between 10 and 20% of the world’s population. (WHO, 2023) According to one study:

• Denmark has the lowest rate of PPD, at 6.48%. (Nature, 2021)
• Afghanistan has the highest rate of PPD, at 61%. (Nature, 2021)

Postpartum depression statistics in the U.S.

• Women in Idaho have the highest prevalence of PPD, at 25.4%. (United Health Foundation, 2023)
• Vermont has the lowest incidence of postpartum depression, at 8.7%. (United Health Foundation, 2023)
• Between 28% and 70% of mothers with infants in Neonatal ICUs reported symptoms of PPD. (United Health Foundation, 2023)

Postpartum depression statistics by race and ethnicity

• Twenty-one percent of white women in the U.S. reported symptoms of PPD in the U.S. (AJOG, 2023)
• About 19% of Hispanic women in the U.S. reported PPD. (AJOG, 2023)
• Twenty-two percent of Black Americans reported PPD. (AJOG, 2023)
• About 14% of Asian/Pacific Islanders reported PPD. (AJOG, 2023)

Postpartum depression statistics by age

• Women younger than 19 years of age have a 22.2% incidence of PPD. (CDC, 2018)
• Women 20 to 24 years of age have a 17.8% incidence of PPD. (CDC, 2018)
• Women 25 to 34 years of age have an 11.9% incidence of PPD. (CDC, 2018)
• Women older than 35 have a 10.8% incidence of PPD (CDC, 2018). 

Postpartum depression and overall health

Postpartum depression can impact every aspect of a new mom’s well-being and health. Not only that, but it can also affect the well-being of children and families. “With more persistent 

sadness comes loss of interest in activities, changes in sleep patterns, changes in appetite, feelings of hopelessness, and difficulty concentrating,” MacBride explains. Those factors play a role in every facet of physical and mental health. New moms may lose or gain weight in ways that impact their health or engage in unhealthy coping behaviors. 

When left untreated, PPD can hinder bonding and healthy attachment to the newborn or distort the mother’s perception of the infant’s behavior. 

“Birthing parents may misjudge or over-interpret baby’s signs, or they might miss cues,” MacBride explains. Basically, PPD can impair the birthing parent’s attention and judgment in ways that are detrimental to the new mom’s health and the health of the baby.

Causes of postpartum depression

PPD is generally attributed to hormonal fluctuations, but other risk factors have to be taken into consideration. MacBride says that it’s difficult for researchers to pin down exact causes when there are so many variables that go into studies on PPD. But, she says, our culture plays a role. “We believe that if you are in a culture in which you perceive support after giving birth and can express emotions or worries openly, you probably find culture helpful,” says MacBride. “If you believe you need to bear it in silence and must bond and be happy about parenthood, you might experience a greater risk for PPD.”

Socioeconomic factors, stressful life events, and neglecting maternal mental health also play a role. “Normal pregnancy, childbirth, and the postpartum period is stressful in the first place and can be an emotionally vulnerable time,” Dr. Juusela says. Juusela explains that this already emotionally fraught time can be exacerbated by additional stressors, such as medical complications of pregnancy (gestational diabetes, preterm labor, preeclampsia), infant health, relationship or family issues, intimate partner violence, financial concerns, unstable housing, and myriad other stressors can increase the risk of anxiety and depression.

Postpartum depression prevention

The best way to prevent PPD is to receive proper care and support during pregnancy. Expectant moms who have a history of mood disorders can start or continue taking mental health medications. 

“Compared to those who do not receive treatment, pregnant persons who are treated for depression during pregnancy are at decreased risk of preterm birth, having a baby born with low birth weight, or feeling an inability to bond emotionally with their baby,” Dr. Juusela says. “During pregnancy, medications called selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat major depressive disorder. SSRI use during pregnancy is effective and generally considered safe.”

In other words, if you already have risk factors such as a history of depression, anxiety disorders, bipolar disorder, family history of mental disorder, mental illness, or postpartum psychosis, make sure you get help when you become pregnant.

Treating postpartum depression

There are multiple screening tools to help detect PPD, and these are valuable tools. “Two of the most commonly used for peripartum depression are the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9),” Dr. Juusela says. “Both tools are easy to administer, and both are highly effective at ruling postpartum depression in or out.”

After receiving a diagnosis of postpartum depression, there are many ways to treat it. The following can help alleviate PPD symptoms:

• Lifestyle changes: First things first, new moms need sleep, healthy food, exercise, and support from family members and health professionals. MacBride says that she sees a lot of new moms trying to muscle through the first few months without enough help and too few hours of sleep. That can be a dangerous combination for developing PPD and other health problems. 
• Talk therapy: New moms need someone to talk to. “Talk therapy can be very helpful,” MacBride says. “My clients benefit from knowing that what they are going through is normal and it’s a safe place to talk about the things they think they would otherwise be negatively judged for even thinking (although it’s usually very normal and understandable).” If one-on-one talk therapy isn’t available, support groups can offer some relief. If you need a referral, see your primary care health professional. 
• Medication: In addition to traditional antidepressants, there are also new medications aimed specifically at treating PPD. Zurzuvae (zuranolone) was approved by the U.S. Food and Drug Administration (FDA) in 2023 for the treatment of postpartum depression. It’s an oral tablet taken for 14 days. The other PPD-specific treatment is Zulresso (brexanolone), a 60-hour IV infusion treatment approved in 2019. It does require a hospital stay, so Zurzuvae may be more accessible. 

Postpartum depression questions and answers

What percentage of mothers experience postpartum depression?

One in 8 women in the U.S. report depression in the postpartum period. The global prevalence of PPD is between 10 and 20%. 

Which country has the highest rate of postpartum depression?

Afghanistan has the highest prevalence of PPD, at 61%. 

What puts a woman at higher risk for PPD?

Risk factors for PPD include geographic location, culture, age, race, ethnicity, socioeconomic status, age of marriage, history of domestic violence, health, mental illness, and stress.