What is Maternal Depression?
The term maternal depression encompasses a range of conditions that can affect women during pregnancy and up to one year postpartum. This spectrum of conditions includes prenatal depression, the "baby blues," postpartum depression and postpartum psychosis. The table below provides an overview and comparison of these conditions.
Types, Prevalence, and Symptoms of Maternal Depression and Related Conditions
| Type | Onset | Prevalence | Symptoms |
|---|---|---|---|
| Perinatal Depression (Prenatal Depression) | During pregnancy | 10 to 20 percent of pregnant mothers |
|
| Baby Blues | Begins during the first two weeks after delivery (usually in first week, peaking at 3 to 5 days). Symptoms usually resolve by two weeks after delivery. | As high as 80 percent of new mothers |
|
| Postpartum Depression | Usually within the first two to three months post-partum, though onset can be immediate after delivery (distinguishable from "baby blues" as it lasts beyond two weeks post-partum) | 10 to 20 percent of new mothers |
|
| Postpartum Psychosis | Usually starts within 2 to 4 weeks of delivery, but can start as early as 2 to 3 days after delivery (and can occur anytime in the first year). | 1-2 per 1,000 new mothers |
|
Source: National Institute for Health Care Management, 2023.
Postpartum psychosis (PPP)
Postpartum psychosis (PPP) is a severe mental disorder that occurs in 1-2/1,000 deliveries. Rates of PPP in women with bipolar disorder are ~25-50%; rates increase to over 70% if there is also a family history of PPP. PPP often strikes abruptly in the first two weeks after delivery, or it may develop slowly over months if early postpartum depression is untreated. It is important to differentiate PPP from postpartum depression, which is a non-psychotic condition that occurs in 10 – 20 percent of childbearing women.
PPP presents a complex picture of mood cycling, cognitive impairment, and psychosis and includes rapidly shifting moods, agitation, bizarre hallucinations, and delusions; the delusions may be organized around the infant.
The cognitive disorganization and ever changing moods add to the unpredictable nature of this condition, which has a significant risk of suicide and infanticide. The safety of mother and baby is paramount. As such, this illness is a psychiatric emergency that requires immediate hospitalization, resulting in separation of the infant from the mother. On admission, the patient should receive a thorough physical examination, standard blood tests, a metabolic workup, and drug testing.
Preventive strategies are warranted in the prenatal period; these include screening for mood disorders, particularly bipolar disorder in the patient or family. Research suggests that the use of mood stabilizers (primarily lithium) and antipsychotics are the treatments of choice, though electroconvulsive therapy (ECT) may be indicated in certain cases. While the prognosis is good and there are rare episodes between pregnancies, there is a 50% recurrence rate with subsequent childbirth. Recurrence can be reduced with mood stabilizer and antipsychotic medication given before childbirth.
Postpartum psychosis has a unique precipitant, namely childbirth. At this time, an abrupt drop in hormones alters brain neurotransmitters. Recent research suggests an immune system dysregulation similar to that of bipolar disorder, suggesting that PPP is an episode of bipolar disorder complicated by dysregulation of the immune system and an altered neuroendocrine axis.
Prevalence of Maternal Depression
Survey data collected in 2022 from new mothers through the CDC's Pregnancy Risk Assessment Monitoring Systems (PRAMS) indicate that approximately 12.7% of women reported symptoms of postpartum depression within three months after the birth of a child (CDC 2025). Data were collected in 28 states and 3 territories, with the highest prevalences (23.2%, 17.7%, 17.6%) in Northern Mariana Islands, Puerto Rico, and Kentucky respectively and the lowest (8.0%) reported in Rhode Island. In New York State, 11.9% of mothers reported symptoms of postpartum depression after giving birth, 11.5% in New York City and 12.4% in New York State excluding New York City.
2022 NYS PRAMS data showed 9.2% of women were told they had depression after giving birth, 53.1 % of these women received counseling for depression after giving birth, and 61.7% took prescription medication for depression after giving birth.
In 2020, the New York State Department of Health (NYSDOH) reported data from the Pregnancy Risk Assessment Monitoring Systems (PRAMS) examining postpartum depression screening in NYS. The data showed that 82.4% of individuals who received a postpartum checkup were asked about depression, an increase from 76.1% in 2016.
Depression among Fathers
Just as a new baby can introduce factors that contribute to maternal depression, the same can apply to new fathers. Paternal depression, though not as frequently investigated as maternal depression, occurs in approximately 1 in 10 fathers within the first 12 months after delivery, with the peak of onset depression in fathers occuring between 3-6 months following delivery. Symptoms include: higher levels of irritability, frustration and anger; isolation from family and friends; impulsiveness and risk taking; lack of concentration and motivation; and, loss of interest in work, hobbies and sex. Factors that contribute to paternal depression include: a partner with maternal depression, unwanted/un-intended pregnancy, personal or family history of depression or other mental illness. Like maternal depression, paternal depression can have negative impacts on the partner and children. Fathers suffering from paternal depression are more likely to have unhappy relationships with their partners, and are more critical and negative towards their partners. As with maternal depression, paternal depression, independent of the mother's mood, negatively affects the child's development.
Risk Factors for Maternal Depression
The most common risk factor for maternal depression is a previous episode of prenatal or postpartum depression. Other factors associated with maternal depression include:
- personal or family history of anxiety, depression or other mood disorders, including prenatal or postpartum depression;
- current or past history of alcohol or other substance abuse;
- life stress, poor quality or no relationship with the baby's father, lack of social support or absence of a community network;
- unplanned or unwanted pregnancy;
- difficult pregnancy or delivery, including preterm birth, multiple births, miscarriage or stillbirth, birth defects or disabilities or other pregnancy complications;
- white race and non-Hispanic ethnicity;
- maternal age <24 years of age;
- lower maternal socioeconomic status.
While the above factors have been associated with a higher risk for maternal depression, depression also occurs among women without these risk factors.
Health Risks of Maternal Depression to Mother and Infant/ Partner/ Family
Maternal depression affects the entire family, and may have significant adverse effects on the health of both the mother and infant. Strong and consistent evidence indicates that a mother's untreated depression undercuts young children's development, and can affect learning, academic success, and success later in life.. Maternal depression can cause "lasting effects on [children's] brain architecture and persistent disruptions of their stress response systems."
A thorough review of this research by the National Research Council and Institute of Medicine finds that maternal depression endangers young children's cognitive, socio-emotional and behavioral development, as well as their learning, and physical and mental health over the long term. Depression disproportionately affects low-income mothers, putting their children at the highest risk for poor developmental outcomes. For low-income mothers, depression is embedded in an array of risk factors including financial and housing instability, lack of social supports and limited resources. Mothers of young children living in poverty and deep poverty are particularly affected by depression. Rates of depression for mothers of young children go up as income goes down. About one in nine infants living in poverty has a mother who is severely depressed, and more than half have a mother experiencing some level of depression. Homeless mothers also experience disproportionately high rates of depression, often compounded by their circumstances.
Maternal depression can significantly affect the ability of mothers and infants to form healthy and secure emotional bonds and reduce the quality of maternal-infant interactions, which in turn can have serious and permanent impacts on children's health and development. Children born to mothers with maternal depression are at higher risk for:
- delays in social, emotional, cognitive and physical development;
- long-term mental health problems;
- reduced utilization of preventive health care services (such as immunizations) and higher use of emergency rooms and other medical services;
- lack of breastfeeding and early discontinuation of breastfeeding.
Maternal depression can also impact overall family functioning, and increase the risk for paternal depression.
