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Significant Distress and General Functional Impairment

  • Postpartum depression (PPD) is not significantly different from Major Depressive Disorder (MDD) in terms of severity and impact of the disorder on functioning.1, 2


  • Significantly higher rate of suicide in mothers with psychiatric disorders such as PPD.2-4
    • 20% of maternal deaths during the postpartum are classified as suicides.4
    • Suicide is one of the leading causes of death in women with PPD.4
  • Most maternal suicides occur after childbirth.5
    • First 4-12 weeks postpartum is the time of greatest risk for suicide in mothers.4, 5


  • Increased prevalence of anxiety symptoms in PPD than in MDD without postpartum-onset.1, 6, 7
  • High comorbidity of PPD with anxiety disorders.8, 9
    • In studies of PPD, between 33.9% and 46% of women presented with comorbid anxiety disorders. 8, 9
    • Overall prevalence rates for co-occurring PPD and anxiety disorders reported from 2.10% to 4.02%.8, 10
  • Commonly comorbid anxiety disorders include generalized anxiety disorder11 and obsessive-compulsive disorder.9

Poor Sleep Quality

  • Women with PPD have poorer sleep quality than women without PPD.12, 13
    • Study found that women with PPD took longer to fall asleep, had more episodes of waking after falling asleep, and had shorter sleep episodes, all of which contributed to lower sleep efficiency.13
    • Sleep quality declined in relation to the severity of PPD symptoms.13

Persistent Duration and Recurrence

  • Course and recurrence not significantly different from major depressive disorder without postpartum-onset,1 with an average illness length of 20.7 years, and an average of 3.06 total episodes.14
  • Although some women experience episodes of PPD that remit within 3 months, a significant proportion of women remain depressed up to two years later.15-17
    • One study found that over one-third of mothers with PPD at two months remained depressed at three, six, twelve, and eighteen months postpartum,15, 16 while another found that mothers with depression after ten to twelve weeks postpartum remained depressed 2 years later.17
  • Depression that persists after three months postpartum is associated with longer duration of PPD and greater risk of subsequent episodes of depression.18
    • Compared to women without PPD, one study found that women with PPD were six times more likely to experience recurrent depression, and were more likely to experience mental or physical illness in the four years after childbirth.19


Impaired Maternal Role Functioning

  • Less gratification and self-efficacy in the maternal role.20
    • Due to the symptoms of depression, many mothers do not experience positive emotions or a sense of accomplishment when performing infant care activities and interacting with their infants.20
    • Often feel intense guilt and perceive themselves as less-effective, or even bad, mothers.20
  • Less likely to engage in optimal infant care practices.20-23
    • Studies have found that depressed mothers are less likely to continue breastfeeding after 2 months,22 and are less likely to use “back-to-sleep” and other healthy sleep practices.23
  • Compromised use of infant healthcare services.20, 21, 24, 25
    • In studies, mothers with PPD were less likely to provide well-child visits & immunizations,24, 25 and their children were more likely to sustain injuries and had more ER visits by age three.25

Mother-Infant Relationship

Detrimental Impact on Mother-Infant Relationship

  • Fewer positive mother-infant interactions.23, 26
    • PPD is moderately associated with negative mother-infant interactions in which the mother is disengaged or has a demeanor of hostility and irritability toward the infant.26
    • Conversely, positive social interactions or active, pleasurable activities such as play, singing, and reading are weakly associated with PPD.22, 23, 26
  • Due to the persistent negative affect and disengagement that is common in depressed mothers, the mothers’ ability to interpret and respond appropriately to the infant’s emotional and social needs is impaired, and infants are less likely to have secure attachment status.27, 28


Higher risk for detrimental developmental outcomes.29-31

Psychiatric Disorders

  • Higher risk of developing psychiatric disorders32, 33
    • Compared to the children of mothers without PPD, a longitudinal study found that the 11 year old children of mothers with PPD had four-times the risk of having a psychiatric disorder, with anxiety disorders being among the most common.32
    • Another longitudinal study found that mothers with PPD at two months postpartum had offspring with significantly higher rates of anxiety disorders 13 years later.33

Behavior Problems

  • By age four, children of mothers with PPD are at greater risk of behavior problems,34 which continues into adolescence.35
    • A longitudinal study found that mothers with PPD at three months postpartum had a greater risk of having offspring with behavior problems 11 years later.36
    • PPD also predicted violent and aggressive behaviors such as using weapons, engaging in physical fights, and bullying classmates and siblings.36
  • Higher risk of behavior disorders such as Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD).32

Impaired Cognitive Development and Academic Achievement

  • A longitudinal study that followed mothers with and without PPD from three months postpartum found that the children of mothers with PPD had significantly lower Wechsler Full Scale Intelligence Quotient (FSIQ) scores at both 11 years and 16 years of age.37, 38
    • Boys were more severely impacted than girls, with the boys whose mothers had PPD scoring more than 20 points below the average FSIQ score of boys whose mothers did not have PPD at both 11 years (89.3 vs. 100.3) and 16 years (80.9 vs. 103.1).37, 38
  • Another longitudinal study found that at age 16 the male offspring of mothers with PPD had significantly lower General Certificate of Secondary Education (GCSE) exam scores, indicating lower academic achievement.39
  • Based on these studies, it appears that boys are more vulnerable to the adverse effect of PPD on cognitive development37, 38 and academic achievement.39


  1. American Psychiatric Association. (2010). Practice guidelines for the treatment of major depressive disorder (3rd ed.). doi: 10.1176/appi.books.9780890423387.654001
  2. Scottish Intercollegiate Guidelines Network. (2002). Postnatal depression and puerperal psychosis: A national clinical guideline. Retrieved from http://www.sign.ac.uk/pdf/sign60.pdf
  3. The Confidential Enquiry into Maternal and Child Health (2007). Saving mothers’ lives: Reviewing maternal deaths to make motherhood safer – 2003-2005. Obstetric Medicine, 1, 1-54. Retrieved from http://www.pbh.gov.br/smsa/bhpelopartonormal/estudos_cientificos/arquivos/saving_mothers_lives.pdf
  4. Lindahl, V., Pearson, J. L., & Colpe, L. (2005). Prevalence of suicidality during pregnancy and the postpartum. Archives of Women’s Mental Health, 8(2), 77-87. doi: 10.1007/s00737-005-0080-1
  5. Centre for Maternal and Child Enquiries (2011). Saving mothers’ lives: Reviewing maternal deaths to make motherhood safer, 2006–08. British Journal of Obstetrics and Gynecology, 118, 1–203. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2010.02847.x/pdf
  6. Ross, L. E., Evans, S. E. G., Sellers, E. M., & Romach, M. K. (2003). Measurement issues in postpartum depression part 1: Anxiety as a feature of postpartum depression. Archives of Women’s Mental Health, 6(1), 51. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=aph&AN=9243058&site=ehost-live&scope=site
  7. Hendrick, V., Altshuler, L., Strouse, T., & Grosser, S. (2000). Postpartum and nonpostpartum depression: Differences in presentation and response to pharmacologic treatment. Depression & Anxiety, 11(2), 66-72. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=aph&AN=11772892&site=ehost-live&scope=site
  8. Reck, C., Struben, K., Backenstrass, M., Stefenelli, U., Reinig, K., Fuchs, T., . . . Mundt, C. (2008). Prevalence, onset and comorbidity of postpartum anxiety and depressive disorders. Acta Psychiatrica Scandinavica, 118(6), 459-468. doi:10.1111/j.1600-0447.2008.01264.x
  9. Sharma, V., Khan, M., Corpse, C., & Sharma, P. (2008). Missed bipolarity and psychiatric comorbidity in women with postpartum depression. Bipolar Disorders, 10(6), 742-747. doi:10.1111/j.1399-5618.2008.00606.x
  10. Matthey, S., Barnett, B., Howie, P., & Kavanagh, D. J. (2003). Diagnosing postpartum depression in mothers and fathers: Whatever happened to anxiety? Journal of Affective Disorders, 74(2), 139. doi:10.1016/S0165-0327(02)00012-5
  11. Nonacs, R. M. (2005). Postpartum mood disorders. In L. S. Cohen & R. M. Nonacs (Eds.), Review of psychiatry: Mood and anxiety disorders during pregnancy and postpartum (Vol. 24, pp. 77-96). Washington, DC: American Psychiatric Publishing.
  12. Dorheim, S. K., Bondevik, G. T., Eberhard-Gran, M., & Bjorvatn, B. (2009). Sleep and depression in postpartum women: A population-based study. Sleep, 32(7), 847-855. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=lhh&AN=20093206482&site=ehost-live&scope=site
  13. Posmontier, B. (2008). Sleep quality in women with and without postpartum depression. Journal of Obstetric, Gynocologic, & Neonatal Nursing, 37(6), 722-737. doi: 10.1111/j.1552-6909.2008.00298.x
  14. Serretti, A., Olgiati, P., & Colombo, C. (2006). Influence of postpartum onset on the course of mood disorders. BMC Psychiatry, 6, 4-7. doi:10.1186/1471-244X-6-4
  15. Beeghly, M., Olson, K. L., Weinberg, M. K., Pierre, S. C., Downey, N., & Tronick, E. Z. (2003). Prevalence, stability, and socio-demographic correlates of depressive symptoms in black mothers during the first 18 months postpartum. Maternal & Child Health Journal, 7(3), 157-168. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=c8h&AN=2004033558&site=ehost-live&scope=site
  16. Beeghly, M., Weinberg, M. K., Olson, K. L., Kernan, H., Riley, J., & Tronick, E. Z. (2002). Stability and change in level of maternal depressive symptomatology during the first postpartum year. Journal of Affective Disorders, 71(1-3), 169. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=aph&AN=7859210&site=ehost-live&scope=site
  17. Horowitz, J. A., & Goodman, J. (2004). A longitudinal study of maternal postpartum depression symptoms. Research & Theory for Nursing Practice, 18(2), 149-163. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=c8h&AN=2005015854&site=ehost-live&scope=site
  18. Hay, D. F., Pawlby, S., Sharp, D., Asten, P., Mills, A., & Kumar, R. (2001). Intellectual problems shown by 11-year-old children whose mothers had postnatal depression. Journal of Child Psychology & Psychiatry & Allied Disciplines, 42(7), 871. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=aph&AN=5557449&site=ehost-live&scope=site
  19. Josefsson, A., & Sydsjö, G. (2007). A follow-up study of postpartum depressed women: Recurrent maternal depressive symptoms and child behavior after four years. Archives of Women’s Mental Health, 10(4), 141-145. doi:10.1007/s00737-007-0185-9
  20. Logsdon, M. C., Wisner, K. L., & Pinto-Foltz, M. (2006). The impact of postpartum depression on mothering. Journal of Obstetric, Gynecologic & Neonatal Nursing, 35(5), 652-658. Retrieved from https://auth.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=2009291246&site=ehost-live&scope=site
  21. Field, T. (2010). Postpartum depression effects on early interactions, parenting, and safety practices: A review. Infant Behavior and Development, 33(1), 1-6. doi: 10.1016/j.infbeh.2009.10.005
  22. McLearn, K. T., Minkovitz, C. S., Strobino, D. M., Marks, E., & Hou, W. (2006). Maternal depressive symptoms at 2 to 4 months postpartum and early parenting practices. Archives of Pediatrics & Adolescent Medicine, 160(3), 279-284. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=c8h&AN=2009330888&site=ehost-live&scope=site
  23. Paulson, J. F., Dauber, S., & Leiferman, J. A. (2006). Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior. Pediatrics, 118(2), 659-668. doi: 10.1542/peds.2005-2948
  24. Zajicek-Farber, M. L. (2009). Postnatal depression and infant health practices among high-risk women. Journal of Child and Family Studies, 18, 236–245. doi: 10.1007/s10826-008-9224-z
  25. Minkovitz, C. S., Strobino, D., Scharfstein, D., Hou, W., Miller, T., Mistry, K. B., & Swartz, K. (2005). Maternal depressive symptoms and children’s receipt of health care in the first 3 years of life. Pediatrics, 115(2), 306-314. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=c8h&AN=2005091432&site=ehost-live&scope=site
  26. Lovejoy, M. C., Graczyk, P. A., O’Hare, E., & Neuman, G. (2000). Maternal depression and parenting behavior: A meta-analytic review. Clinical Psychology Review, 20(5), 561-592. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=flh&AN=FLH3778232535&site=ehost-live&scope=site
  27. Martins, C., & Gaffan, E. A. (2000). Effects of early maternal depression on patterns of infant-mother attachment: A meta-analytic investigation. Journal of Child Psychology & Psychiatry & Allied Disciplines, 41(6), 737. Retrieved from https://auth.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=3673783&site=ehost-live&scope=site
  28. Coyl, D. D., Roggman, L. A., & Newland, L. A. (2002). Stress, maternal depression, and negative mother–infant interactions in relation to infant attachment. Infant Mental Health Journal, 23(1), 145-163. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=aph&AN=11772372&site=ehost-live&scope=site
  29. Craig, M., & Howard, L. (2008). Postnatal depression. Retrieved from Clinical Evidence http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907780/pdf/2009-1407.pdf
  30. Wisner, K. L., Parry, B. L., & Piontek, C. M. (2002). Postpartum depression. New England Journal of Medicine, 347(3), 194-199. doi: 10.1056/NEJMcp011542
  31. Tronick, E., & Reck, C. (2009). Infants of depressed mothers. Harvard Review of Psychiatry, 17(2), 147-156. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=eoah&AN=18476083&site=ehost-live&scope=site
  32. Pawlby, S., Sharp, D., Hay, D., & O’Keane, V. (2008). Postnatal depression and child outcome at 11 years: The importance of accurate diagnosis. Journal of Affective Disorders, 107(1-3), 241-245. doi: 10.1016/j.jad.2007.08.002
  33. Halligan, S. L., Murray, L., Martins, C., & Cooper, P. J. (2007). Maternal depression and psychiatric outcomes in adolescent offspring: A 13-year longitudinal study. Journal of Affective Disorders, 97(1-3), 145-154. doi: 10.1016/j.jad.2006.06.010
  34. Josefsson, A., & Sydsjö, G. (2007). A follow-up study of postpartum depressed women: Recurrent maternal depressive symptoms and child behavior after four years. Archives of Women’s Mental Health, 10(4), 141-145. doi: 10.1007/s00737-007-0185-9
  35. Beck, C. T. (1999). Maternal depression and child behaviour problems: A meta-analysis. Journal of Advanced Nursing, 29(3), 623-629. doi: 10.1046/j.1365-2648.1999.00943.x
  36. Hay, D. F., Pawlby, S., Angold, A., Harold, G. T., & Sharp, D. (2003). Pathways to violence in the children of mothers who were depressed postpartum. Developmental Psychology, 39(6), 1083-1094. doi: 10.1037/0012-1649.39.6.1083
  37. Hay, D. F., Pawlby, S., Sharp, D., Asten, P., Mills, A., & Kumar, R. (2001). Intellectual problems shown by 11-year-old children whose mothers had postnatal depression. Journal of Child Psychology & Psychiatry & Allied Disciplines, 42(7), 871. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=aph&AN=5557449&site=ehost-live&scope=site
  38. Hay, D. F., Pawlby, S., Waters, C. S., & Sharp, D. (2008). Antepartum and postpartum exposure to maternal depression: Different effects on different adolescent outcomes. Journal of Child Psychology and Psychiatry, 49(10), 1079-1088. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=eric&AN=EJ814291&site=ehost-live&scope=site; http://dx.doi.org.libproxy.lib.unc.edu/10.1111/j.1469-7610.2008.01959.x
  39. Murray, L., Arteche, A., Fearon, P., Halligan, S., Croudace, T., & Cooper, P. (2010). The effects of maternal postnatal depression and child sex on academic performance at age 16 years: A developmental approach. Journal of Child Psychology & Psychiatry, 51(10), 1150-1159. doi: 10.1111/j.1469-7610.2010.02259.x\

Last Updated July 15, 2011