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TOPLINE:

Major depressive disorder (MDD) affected approximately 6% of women and girls during pregnancy and 7% in the first year after birth, with the prevalence peaking in the first 2 weeks after delivery, a study showed. The analysis also revealed that commonly used symptom scales — such as the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ) — overestimated the prevalence of MDD by 71%-122% compared to diagnostic interviews.

METHODOLOGY:

• A systematic review and meta-regression of 780 studies published between 1980 and 2025 included more than 2 million women and girls aged 10-59 years (mean age, 30 years) from 90 countries.
• Researchers examined more than 1500 data points from cross-sectional or longitudinal surveys to assess the prevalence of MDD during pregnancy and up to 12 months postpartum.
• The included studies used structured diagnostic instruments or clinical interviews conducted by mental health professionals to diagnose MDD and scales such as the EPDS, PHQ, and Beck Depression Inventory (BDI) to assess symptoms of depression.
• The primary outcome measure was prevalence of perinatal MDD through the first year after birth. Secondary outcomes were temporal shifts in prevalence across gestational weeks and postpartum days, with adjustments for the effect of “baby blues,” defined as fluctuations in mood and feelings of exhaustion within the first 2 weeks postpartum.

TAKEAWAY:

• After adjusting for changes over the peripartum period and measurement error-related biases, MDD prevalence was 6.2% during pregnancy and remained elevated at 6.8% during the year after birth after adjusting for effects of baby blues.
• The prevalence of MDD peaked during and at the end of the first 2 weeks postpartum (9.8% and 8.3%, respectively; P < .0001).
• The highest prevalence was observed in southern sub-Saharan Africa (ranging from 16% during pregnancy to 17% in the postpartum year) and South Asia (ranging from 14% during pregnancy to 15% in the postpartum year); the lowest prevalence was observed in the high-income Asia-Pacific region (3% during pregnancy and in the postpartum year).
• The odds of an MDD diagnosis during pregnancy were 110%, 122%, and 105% higher with the EPDS, PHQ, and BDI, respectively, than with diagnostic interviews. The odds of an MDD diagnosis after giving birth were 71% and 83% higher with the EPDS and PHQ, respectively, than with diagnostic interviews (P < .0001 for all).

IN PRACTICE:

“Prevention, early identification, and intervention strategies for MDD are needed in the peripartum period, especially in the first 2 weeks postpartum when prevalence of MDD is highest. Our detailed findings will help stakeholders to understand when and where screening and intervention are required and offer a baseline against which progress of intervention strategies can be monitored over time,” the investigators wrote.

SOURCE:

The study was led by Alize J. Ferrari, PhD, and Paul A. Miller, PhD, both from Queensland Centre for Mental Health Research, Wacol, Australia. It was published online on April 30 in The Lancet Psychiatry.

LIMITATIONS:

Researchers could not determine the time of onset of MDD; some cases may have predated pregnancy. Findings were not generalizable to all peripartum populations globally, particularly in countries where survey data were limited. The scarcity of diagnostic interviews in these regions limited cross-national validity of bias corrections. Estimates potentially underestimated MDD prevalence in locations where peripartum women and girls do not maintain regular contact with health services. The exclusion of effects of baby blues when estimating postpartum prevalence may have led to misclassification of true incident MDD cases, potentially underestimating the prevalence.

DISCLOSURES:

The study was funded by Queensland Health, The University of Queensland, and the Gates Foundation. Disclosure information for the study investigators is available in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.