Postpartum Depression (PPD): Timely Identification and Management of Patients

Check out our latest video for insights into Postpartum Depression (PPD) and the importance of early identification in the patient journey!

Julie A. Carbray, PhD, APRN
This module was medically reviewed by Julie Carbray, PhD, APRN, Clinical Professor of Psychiatry and Nursing, University of Illinois, Chicago.





Postpartum depression, or PPD, affects about 1 in 8 mothers who have a live birth in the United States.

Symptoms of PPD include low mood, sleep disturbances, changes in appetite, poor concentration, irritability, and/or concerns or guilt about the inability to take care of the baby.

PPD symptoms are among the most common medical complications affecting mothers during and after pregnancy.

These symptoms often occur within a few months and can last up to a year after birth.

In fact, according to the Diagnostic and Statistical Manual of Mental Disorders fifth edition, or DSM-5, 50% of ‘postpartum’ major depressive episodes actually begin prior to delivery, during pregnancy. These are called peripartum episodes.

Risk factors for PPD include stressful life events, history of sexual, physical, and/or verbal abuse, domestic violence, diminished self-esteem, childcare stress, prenatal anxiety, previous episodes of PPD, marital conflicts, and single parenthood.

Depression during pregnancy can have significant negative effects on maternal outcomes such as slower fetal development, low birth weight, preterm labor, preterm birth, maternal anemia and diabetes, hypertensive disorders such as preeclampsia, increased risk for maternal substance abuse, and cesarean section.

PPD can affect socialization behaviors in both the mother and the child. These effects can lead to deeper depression. PPD can impair a mother’s ability to care for herself and her infant, negatively impacting the child’s cognitive, behavioral, and emotional development.

Furthermore, postpartum depression can lead to impaired mother-infant bonding and, if left untreated, can lead to increased risk of suicide and infanticide.

Infants born to depressed mothers can be more irritable, less active, and more likely to experience developmental delays, among other effects on health and growth.

Some of the most common interventions used to manage PPD include pharmacological interventions with antidepressants, psychosocial support, interpersonal psychotherapy, and cognitive behavioral therapy.

Despite the availability of interventions, unmet needs remain for PPD.

Although PPD is a common mental health disorder experienced by mothers both during pregnancy and after birth, it is underdiagnosed and undertreated.

Some barriers preventing or delaying treatment for PPD are the stigma around mental health disorders, the difficulty in accessing mental health resources, and the patients’ lack of awareness of PPD symptoms and treatment options.

PPD screening tools are available. However, the diagnostic criteria and recommended screening periods are inconsistent among sources. This may result in inaccurate or missed diagnoses of mothers with PPD.

Self-reported data from more than 32,000 mothers with live births in the United States show that 1 in 8 mothers were not asked about depression during a postpartum doctor visit, and 1 in 5 were not asked at a prenatal visit.

Furthermore, some patients who have a positive screening for PPD symptoms will still not meet the criteria for a PPD diagnosis, as assessed by the Structured Clinical Interview for DSM Disorders (SCID).

Variations in the screening period for detecting symptoms of PPD also complicate diagnosis. One international systematic review of studies between 2001 and 2016 showed that 75% of PPD screening occurred between birth and 6 months postpartum. But, according to the DSM-5-TR, patients can present symptoms up to 12 months postpartum.

Knowing that symptoms of PPD can begin during pregnancy suggests that screening for this disorder should become more routine throughout pregnancy. 

Likewise, screening should continue up to 12 months postpartum to provide the best care for patients.

Clinicians can use tools to ask investigative questions about anxious thoughts, lack of enjoyment in daily life, difficulty sleeping, or thoughts of self-harm.

Overall, PPD places a heavy burden on the mother and on the family as a whole.

Early identification and treatment of PPD can lead to improved outcomes for patients and their families, minimize the associated emotional burdens, and aid in relapse prevention.