A survey of 975 mothers from German-speaking countries found that postpartum depression was most strongly associated with stress during the first six weeks after birth, depression during pregnancy, loneliness and feeling less satisfied with available support.
The findings point to the importance of emotional wellbeing and perceived support around pregnancy and early parenthood. They do not show that any one factor causes postpartum depression or predict what will happen to an individual mother.
Early post-birth stress showed the strongest link
Feeling stressed by one’s general life situation during the first six weeks after birth had the strongest association measured in the survey. The strength of this relationship was reported as Cramer’s V of 0.48, a measure that ranges from 0 for no link to 1 for a perfect link.
Mothers classified in the depression group averaged 3.84 on a five-point agreement scale for general-life stress, compared with 2.50 among the comparison group. Stress related to surroundings, money and medical reasons was also more common in the depression group.
Sleep problems unrelated to the baby’s sleep were reported by 34.9% of the depression group and 6.5% of controls. However, sleep disruption can be both a symptom of depression and a possible trigger, so the survey cannot establish which came first.
Prenatal depression and loneliness were also associated
Depression during pregnancy was reported by 24.2% of mothers in the depression group and 3.2% of the comparison group. Within those figures, 7.4% of the depression group reported a clinical diagnosis of prenatal depression, while 16.8% recognized it in themselves without that diagnosis. The corresponding figures in the control group were 0.8% and 2.4%.
A history of depression was also more common among mothers in the depression group: 44.3%, compared with 21.0% of controls. During pregnancy, the depression group reported more loneliness and general stress, felt less confident that support would be available if needed, and reported lower average happiness.
Feeling supported may matter
After birth, mothers in the depression group gave lower ratings for how supported they felt by medical care, family and friends, and partners. These ratings described perceived support and satisfaction, not the objective amount of help received.
The group with postpartum depression also reported lower satisfaction with how the birth went and with their control over decisions. Birth was described as traumatic by 41.5% of this group, compared with 17.7% of the comparison group.
These findings suggest that conversations about emotional health and support may be relevant during pregnancy and after birth. They also underline that support can involve how help is experienced, not only whether assistance is technically available.
What the survey did—and did not—show
Ricarda Volz and colleagues at the University of Freiburg conducted the anonymous online questionnaire. Participants had given birth within the previous five years, but not within the previous six weeks. About 96% lived in Germany, 53% had a university degree and 86% were employed.
Participants reported on 53 possible factors from before pregnancy through the first six weeks after birth. The 284 women who said they had experienced postpartum depression formed the initial case group. A further 186 women with scores of 13 or higher on an Edinburgh Postnatal Depression Scale questionnaire adapted to ask about the weeks after birth were classified as probable, previously unrecognized cases. Together, these 470 women made up the case group, while 505 women scoring below 13 formed the control group.
Medical and birth-related factors—including cesarean delivery, birth mode, induction, preterm birth, gestational diabetes, preeclampsia, thyroid problems, severe pregnancy nausea, polycystic ovary syndrome, migraine and high blood pressure after birth—showed no significant link in this survey. The researchers did not measure hormones, inflammation or other biological markers.
Because the survey relied on an online convenience sample and memories of pregnancies and births up to five years earlier, the results may not represent all mothers. Each factor was tested on its own rather than being adjusted for the others, so the study cannot show which factors are independently associated with postpartum depression. The adapted questionnaire used for some case classifications has also not been validated for long-term recall.
Postpartum depression affects an estimated 10% to 20% of new mothers, and about half of cases are never recognized, according to the fact sheet. Persistent low mood or other troubling symptoms after birth warrant attention from a qualified healthcare professional; the survey’s findings should not be used to diagnose anyone.
AI tools were used to assist with the preparation of this article.
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