Moms at Highest Risk for Postpartum Depression Identified

Summary: Younger mothers, first-time moms, and women who give birth to twins are at the highest risk of developing postpartum depression, a new study reports.

Source: University of Virginia

The risk for postpartum depression is highest among first-time mothers, mothers younger than 25 years old and mothers of twins, according to a survey of more than 1.1 million moms worldwide. 

Moms older than 40 years old having twins are at the highest risk, researchers from the University of Virginia School of Medicine, Johns Hopkins University and Flo Health found.

“The size of this study, in over 1 million new mothers, make the findings highly significant and definitive. Most studies on postpartum depression are small and confined to a small region. This study answers questions about risk factors for postpartum depression from a worldwide sample,” said Jennifer L. Payne, MD, the study’s senior author and director of the Reproductive Psychiatry Research Program at the UVA School of Medicine.

Better Understanding Postpartum Depression Risk Factors

It is vital to better identify the risk factors for postpartum depression, the researchers said, because of the potential health effects on both moms and their children. For example, the researchers highlight that women are twice as likely as men to experience depression during their childbearing years. Women are also at increased risk of experiencing major depression after giving birth.

Children of women who experience postpartum depression are more likely to develop major depression and other psychiatric disorders, the researchers note. Having a mother who experiences postpartum depression is also associated with developmental challenges for children, including lower IQs and slower language development.  

“There is a growing necessity to identify risk factors that place women at elevated risk, prior to the onset of affective illness, during this vulnerable time-period so that preventive measures can be instituted,” the researchers write.

To better understand the risk factors for postpartum depression, the researchers analyzed responses from more than 1.1 million new mothers to the “After Childbirth Survey” on the Flo app, which helps women track their period and menstrual cycle. 

This shows a depressed woman
It is vital to better identify the risk factors for postpartum depression, the researchers said, because of the potential health effects on both moms and their children. Image is in the public domain

By age group, the percentage of women self-reporting postpartum depression symptoms was highest among 18- to 24-year-olds, at 10%. The rate of postpartum depression then steadily declined by increasing age, dropping to 6.5% for 35- to 39-year-olds, before increasing slightly to 6.9% among women 40 and older. Across all age groups, postpartum depression was significantly lower among women who had previously had children compared with first-time moms.

Women who had twins were more likely to report postpartum depression – 11.3% of mothers of twins reported symptoms, compared with 8.3% of mothers of a single child. This difference was especially pronounced among moms ages 40 and older; 15% of moms in this age group having twins reported postpartum depression symptoms, compared with 6.6% of mothers of one baby. Women older than 40 having twins, the researchers concluded, are at “markedly high risk” for postpartum depression. 

The researchers found no significant difference in the rates of postpartum depression between mothers of boys or girls.

“Most women with postpartum depression are not diagnosed or treated. Clinicians caring for new mothers can be aware of factors like age, first pregnancy and twin pregnancies that put women at a higher risk of developing postpartum depression and screen and intervene early,” Payne said. “Early intervention can prevent the negative outcomes associated with postpartum depression for both mothers and their children.”

About this postpartum depression research news

Author: Josh Barney
Source: University of Virginia
Contact: Josh Barney – University of Virginia
Image: The image is in the public domain

Original Research: Open access.
Risk factors associated with postpartum depressive symptoms: A multinational study” by  Jennifer L. Payne et al. Journal of Affective Disorders


Risk factors associated with postpartum depressive symptoms: A multinational study


To evaluate the association between maternal age, parity, gestational number (singleton vs twin), newborn gender and self-reported postpartum depressive symptoms (PDS) in a large multinational sample using survey data from a digital telephone application.


Women using the Flo app answered a survey (available in 10 languages) from January 2018 to April 2020. A survey question asking about emotional state was used to determine the presence of PDS. Chi-squared statistics were used to compare groups. A weighted mean prevalence was calculated based upon the socioeconomic status and reproductive population of each country in 2020.


Over a million women from 138 countries participated. Of all respondents, 9.4% endorsed PDS. The weighted mean prevalence of PDS was 11%. We found that PDS decreased with advancing age. First-time mothers reported higher rates of PDS. Twin births were associated with a higher symptom burden than singleton births and mothers of twins in the oldest age group reported the greatest burden. We did not find a clinically significant difference in rates of PDS between mothers of singleton girls and boys.


To our knowledge, this study is the first to examine risk factors for postpartum symptoms using the same survey across a large international population. These results can further research and clinical aims to identify and treat maternal depression more effectively.


Data was aggregated, thereby limiting analysis of individual associations. The survey was self-report and not diagnostic for postpartum depression. Generalizability of risks of postpartum depression should be approached with caution.

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