Risk factors for postpartum depression: an umbrella review
Min Xu, Yuting Luo, Yuehua Huang, Yunxia Liu, L. Ding
Abstract
Objective: This umbrella review aimed to systematically evaluate and synthesize the evidence on risk factors associated with postpartum depression (PPD), assess the methodological quality and credibility of the existing meta-analyses, and identify high-priority targets for prevention and intervention. Methods: We systematically searched PubMed, Embase, Web of Science, Cochrane Library, and Medicine up to March 2025 for systematic reviews and meta-analyses reporting on risk factors for PPD. Eligible studies were appraised using AMSTAR-2 and GRADE frameworks. Risk factors were categorized based on effect estimates, heterogeneity, publication bias, and evidence strength. Results: Seventy-seven meta-analyses were included, covering 53 unique risk factors. Among these, 40 showed statistically significant associations with PPD. Unintended pregnancy (OR: 1.55), intimate partner violence (OR: 2.50), poor social support (RR: 3.57), sleep disorders (OR: 2.36), and history of depression (OR: 3.09) emerged as the strongest risk factors. Protective factors included postpartum physical activity (SMD: -0.42), doula support (RR: 0.36), breastfeeding support (MD: -2.11), and parenting interventions (SMD: -0.34). Most evidence was rated as low or very low in certainty; only a few outcomes based on randomized controlled trials were graded as moderate to high quality. Conclusions: PPD is influenced by a broad spectrum of psychosocial, biological, and obstetric risk factors. Although many associations are supported by statistical significance, the overall evidence quality remains suboptimal. Targeted screening and preventive strategies should prioritize high-risk groups, while future research should focus on high-quality, prospective studies to establish causal links and improve maternal mental health outcomes. Systematic review registration: PROSPERO (Registration No.: CRD420251249033).