Most studies over the last few decades have estimated the prevalence of postpartum depression (PPD) in the United States to be between 10% and 15%.  According to longitudinal data derived from the Pregnancy Risk Assessment Monitoring System (PRAMS), the prevalence in the US could be decreasing.

Postpartum depression is common and associated with adverse infant and maternal outcomes such as lower breastfeeding initiation and duration and poor mother-infant bonding. The Healthy People 2020 initiative set the objective to to decrease the proportion of women who experience postpartum depressive symptoms (PDS) after delivering a live birth within the US. The CDC sought to describe self-reported PDS overall to provide a baseline for this objective by reporting state and selected sociodemographic factors of mothers.

Using the Pregnancy Risk Assessment Monitoring System (PRAMS) and its collected data from 2004, 2008, and 2012, researchers looked at the prevalence of self-reported PDS in women giving birth in the United States.

In 2012, the overall prevalence of PDS was 11.5% for the 27 states included in the analysis, ranging from 8.0% (Georgia) to 20.1% (Arkansas).  When they looked at the 13 states with data for all three time points, the prevalence of PDS declined from 2004 (14.8%) to 2012 (9.8%) Statistically significant declines in the prevalence of PDS were observed for eight states; no significant changes were observed for five states.

Postpartum depressive symptoms were highest among new mothers who 1) were aged ?19 years or 20–24 years, 2) were of American Indian/Alaska Native or Asian/Pacific Islander race/ethnicity, 3) had ?12 years of education, 4) were unmarried, 5) were postpartum smokers, 6) had three or more stressful life events in the year before birth, 7) gave birth to term, low-birthweight infants, and 8) had infants requiring neonatal intensive care unit admission at birth.

While these findings are exciting, it is important to understand the limitations of the study.  Previous studies assessing the prevalence of  PPD typically have used structured diagnostic interviews to diagnose a depressive episode. In comparison, postpartum women completed questionnaires in the PRAMS:

Self-reported PDS was ascertained through five responses (“always,” “often,” “sometimes,” “rarely,” and “never”) to the following two questions: 1) “Since your new baby was born, how often have you felt down, depressed, or hopeless?” and 2) “Since your new baby was born, how often have you had little interest or little pleasure in doing things?” Women responding “always” or “often” to either question were classified as experiencing PDS. In 2004 and 2008, these two questions were optional and included in 17 and 22 state surveys, respectively; in 2012, these questions were required for all 27 participating PRAMS states.

In eight states, it looks as if the prevalence of “self-reported postpartum depressive symptoms” decreased; however, we must concede that these two questions might be a less accurate measure of the actual prevalence of PPD.  (Although these two questions have been demonstrated to be a reliable screening tool for depressive symptoms in primary care settings.)

We also need to ask why there has been a decrease in the prevalence of PPD. The authors comment, “Although the study did not investigate reasons for the decline, better recognition of risk factors for depression and improved screening and treatment before and during pregnancy, including increased use of antidepressants, might have contributed to the decline.”  While increasing awareness may have contributed to this observed decline, this study also documents relatively high rates of depressive symptoms in certain states (including Arkansas, Oklahoma, Tennessee, and Missouri) and in certain at-risk populations (younger, less educated, and unmarried mothers).

Ruta Nonacs, MD PhD


Trends in Postpartum Depressive Symptoms – 27 States, 2004, 2008, and 2012.

Ko JY, Rockhill KM, Tong VT, Morrow B, Farr SL. MMWR Morb Mortal Wkly Rep. 2017 Feb 17;66(6):153-158.   Free Article


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