Marriage and postpartum major depressive disorder: A systematic review and meta-analysis of cohort studies

Many studies have explored the relationships between demographic variables and postpartum major depressive disorder. However, there is no clear conclusion on the impact of different marital statuses and quality on postpartum major depressive disorder. This systematic review and meta-analysis examined the combined effects of different marital status and quality on postpartum major depressive disorder with cohort studies. Two authors independently searched 6 English databases (PubMed, Medline, Web of Science, PsycARTICLES, EBSCOhost and Scopus) and 3 Chinese databases (China Knowledge Resource Integrated Database (CNKI), Weipu database and Wanfang database) from the beginning of database construction to October 25, 2024. Studies that met the inclusion criteria included maternal diagnosis of postpartum major depressive disorder by clinical diagnostic criteria, inclusion of marital status, and reporting risk estimate. There were no language limitations in this study. The quality of the included studies was assessed using the Newcastle-Ottawa scale (NOS). Publication bias was assessed using a funnel plot and Egger's test. Finally, nineteen cohort studies were included in this meta-analysis. Low marital satisfaction was the most significant predictor of postpartum major depressive disorder (pooled RR = 3.47, 95% CI: 1.96, 6.12) followed by being single/divorced/separated/widowed/unmarried (pooled RR = 1.19, 95% CI: 1.02, 1.39). However, there was not a significant relationship between "worsening relationship/dissatisfaction with partner/problems in marital relationship" and postpartum major depressive disorder (pooled RR = 2.30, 95% CI:0.69, 7.62) yet. Marital status and marriage quality impacted heavily on maternal postpartum major depressive disorder. There is an urgent need to focus on family therapy and marital intervention for pregnant women and to enhance the sense of involvement of the husband or partner.