Epidemiology, pathophysiology, and interventions for postpartum depression: Systematic review

Postpartum depression (PPD) is a prevalent and debilitating psychiatric disorder affecting maternal mental health, infant development, and family well-being. Despite increasing global awareness, significant disparities remain in screening, diagnosis, and treatment, particularly in low-resource and culturally diverse settings. The complex interplay of biological and psychosocial determinants complicates conventional intervention models. Integrating epidemiological patterns, pathophysiological mechanisms, and sociocultural factors will inform more effective and equitable strategies for PPD screening, prevention, and treatment.

To synthesize current evidence on risk factors, underlying mechanisms, and interventions for postpartum depression and outline directions toward equitable care.

A narrative review was conducted following PRISMA 2020 guidelines. Peer-reviewed studies published from January 2010 to May 2025 were systematically searched in PubMed, Web of Science, EMBASE, and PsycINFO. Inclusion criteria comprised studies addressing PPD epidemiology, risk stratification, biological mechanisms, and intervention strategies. After screening and full-text review, 84 studies were included. Study designs primarily involved cohort studies, randomized controlled trials, and meta-analyses. Extracted data were categorized thematically and assessed for methodological quality and generalizability.

PPD arises from multifactorial interactions involving hormonal dysregulation, neurochemical changes, psychosocial stressors, and cultural influences. Primary risk factors include personal or family history of depression, antenatal anxiety, low maternal self-efficacy, and inadequate social support. Evidence-based interventions encompass Edinburgh Postnatal Depression Scale-based screening, cognitive behavioral therapy, interpersonal psychotherapy, psychoeducation, and pharmacological treatments such as brexanolone and zuranolone. Culturally adapted, community-integrated models-including stepped-care approaches and task-shifting-improve feasibility and scalability, particularly in underserved populations. Emerging evidence highlights inflammatory biomarkers (e.g., interleukin-6 and C-reactive protein), AI-assisted screening tools, and family-inclusive strategies as promising for enhanced detection and outcomes.

Effective PPD management requires integrative, culturally sensitive approaches, prioritizing scalable, personalized non-pharmacological interventions to reduce disparities and enhance maternal mental health equity across diverse populations.