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Understanding risk factors for postpartum depression

July 14, 2011

An article entitled, “Is mode of delivery associated with postpartum depression at 6 weeks: a prospective cohort study,” recently published by researchers from McMaster University, York University, the University of Toronto, St. Joseph’s Healthcare Hamilton and Mount Sinai Hospital, examines the relationship between delivery mode (vaginal versus caesarean section) and postpartum depression. This is one piece of a broader study, “The Ontario Mother and Infant Study (TOMIS) III,” which looked at the impact of delivery method on health outcomes, service use, and costs of care in the first postpartum year. A large sample of 2,560 women from 11 hospitals across Ontario participated in the study.

While mode of delivery was not found to be significantly associated with postpartum depression, a number of other variables emerged as potential risk factors which have received little or no representation in the literature and should be explored in more depth in order to inform prevention and intervention strategies. These include:

  • Urinary incontinence;
  • Maternal readmission to hospital; and
  • High number of unmet learning needs in hospital.

See Sword, W. et al. “Is mode of delivery associated with postpartum depression at 6 weeks: a prospective cohort study” (2011), BJOG, 118:966-977, and “The Ontario Mother and Infant Study (TOMIS) III: A multi-site cohort study of the impact of delivery method on health, service use, and costs of care in the first postpartum year” (2009), BMC Pregnancy and Childbirth, 9:16.


A number of other recent studies concerning postpartum depression have come to our attention. This is by no means a systematic update of the work being done in this area, but are presented here for your interest:

Illegas, L., McKay, K., Dennis, C-L., Ross, L.E. (2010) Postpartum depression among rural women from developed and developing countries: A Systematic Review. Journal of Rural Health, doi: 10.1111/j.1748-0361.2010.00339.x

A literature review on the rate of and risk factors for postpartum depression in rural communities within developed and developing countries. Further studies with clearly defined “rural” and “comparison” groups are needed to determine whether living in rural areas is associated with increased risk for postpartum depression in order to improve prevention and treatment programs for rural women.

Vigod, S. N., Villegas, L., Dennis, C.-L., Ross, L.E. (2010) Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: a systematic review, British Journal of Obstetrics & Gynaecology, 117(5), 540-550.

Looks at rates of postpartum depression among women with premature or low-birth weight infants. Methods to identify and prevent postpartum depression in this vulnerable population are needed.

Chivers, M.L., Pittini, R., Villegas, L., Grigoriadis, S., Ross, L.E. The relationship between sexual function and depressive symptomatology in postpartum women: a pilot study. Journal of Sexual Medicine, (in press).

An assessment of current sexual functioning and sexual behaviour in women with and without symptoms of postpartum depression. Further research is needed to better understand the relationship between sexual dysfunction and depression among postpartum women, and to identify prevention and treatment options for both conditions.

Carter, W., Grigoriadis, S., Ross, L.E. (2010) Relationship distress and depression in postpartum women: Literature review and introduction of a Conjoint Interpersonal Psychotherapy Intervention, Archives of Women’s Mental Health, 13(3), 279-284.

Introduces a newly developed couple psychotherapy approach to treating postpartum depression in women who are also experiencing relationship distress. A case study illustrating the successful application of this approach is presented.

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