My time in the perinatal mental health team has made me realise that the perinatal period can be both an exciting and challenging period for mothers. Women experience the joy of motherhood, such as bringing a new life into the world, but at the same time face new responsibilities, changes in roles and social life. Unsurprisingly, the chances of women experiencing mental health difficulties during the perinatal period also increase, with peripartum depression being one of the most common mental health conditions before birth.
The prevalence of peripartum depression among the perinatal population has been a significant public health concern (Nakić Radoš et al., 2025; Yang et al., 2024). Systematic reviews have been done on examining the healthcare services’ adherence to clinical guidelines on screening for peripartum depression and the development of prevention, screening and treatment of peripartum depression.
Identifying the prevalence of perinatal depression during the perinatal period is crucial for the development of service pathways, prevention, and intervention planning. However, existing prevalence estimates in the literature often use inconsistent data collection methods and do not differentiate prevalence rates across the perinatal period (Ferrari et al., 2026).
Noticing the gap in the literature, Ferrari et al. (2026) examined the prevalence of major depressive disorder (MDD) during the perinatal period across global regions. MDD is recognised as a leading cause of disability worldwide (GBD, 2025), yet no prior analysis has quantified what proportion of that burden specifically occurs during the peripartum period. The authors of this study compared the prevalence rate across different stages of the perinatal period and examined the biases arising from inconsistent measurement methods in the literature.
Methods
The research team included studies regarding the prevalence of MDD among girls or women aged from 10 to 59 during pregnancy, the postpartum period, or both across 90 countries. They searched databases including PubMed, Embase, PsycINFO and grey literature that were sourced from collaborators or citation lists of published systematic reviews, for studies published between Jan 1, 1980 and Oct 23, 2025. English and non-English cross-sectional and longitudinal surveys were included. Of 31,812 potentially eligible studies, 25,616 were screened at the title and abstract level, with two reviewers achieving 98% agreement (Cohen’s κ = 0.91) on a dually-screened subset. The PRISMA guidelines were followed, and 780 studies with 1505 prevalence datapoints were included.
The analysis was done in two stages. First, the included studies’ measurement biases were analysed, followed by estimates of MDD prevalence during pregnancy and postpartum periods across different regions using the Global Burden of Disease’s meta-regression – Bayesian, regularised, trimmed (MR-BRT) framework (Zheng et al., 2021). The definition of MDD in the review was based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), but the definition was expanded to include studies that report prevalence up to 12 months postpartum. When correcting for measurement bias, the researchers used DSM-IV as the gold-standard reference definition, as it was the version used by most of the included studies.
Results
After adjusting for measurement errors, the review found that the overall prevalence rates of MDD were 6.2% during pregnancy and 6.8% during the postpartum year. This translates to approximately 1 in 16 pregnant people and 1 in 15 people in their first postpartum year having MDD. The prevalence of MDD was 9.8% during the first two weeks postpartum, although this figure is likely inflated by ‘baby blues’ – the transient low mood many women experience shortly after birth, which is not the same as MDD. Once this was accounted for, the corrected prevalence at the end of the first 2 weeks postpartum was 8.3%, and prevalence across the first 4 postpartum months, also adjusted for baby blues, was 7.3%. The prevalence of MDD remains elevated throughout the whole postpartum period compared to pregnancy.
In terms of prevalence across world regions, the review shows that high-income Asia Pacific has the lowest prevalence rate of MDD (3.1% during pregnancy to 3.3% during post-partum year), whilst the prevalence rate is highest in southern sub-Saharan Africa (15.6% during pregnancy to 16.6% during post-partum year) and South Asia (13.7% and 14.6%).
The review also reported significant variations in measurements used across studies in terms of MDD definitions used, sampling strategies, and use of symptom scales.
Firstly, the review indicates that studies using symptom scales might have overestimated MDD prevalence compared to diagnostic interviews using the DSM-IV definition. Compared to diagnostic interviews, the chances of overestimation were 110.2% for the Edinburgh Postnatal Depression Scale (EPDS), 121.9% for the Patient Health Questionnaire (PHQ), 104.8% for the Beck Depression Inventory (BDI) during pregnancy. During postpartum, the chance of overestimation was 71.3% for EPDS, 83.1% for PHQ, and there is no available data for comparison for BDI.
The prevalence reported also varied depending on the thresholds of symptom scales chosen. For EPDS, each unit increase in the scoring threshold of MDD led to a 27.9% and 25.1% drop in the chances of getting a MDD diagnosis during pregnancy and postpartum period, respectively.
Secondly, differences in MDD definitions used also lead to variation in prevalence rates found. Studies using the definitions of the International Statistical Classification of Diseases and related health problems (ICD-10; World Health Organization, 2016) of MDD instead of that of DSM-IV were 48.1% and 39.9% more likely to report a MDD diagnosis during pregnancy and postpartum period, respectively.
Thirdly, for studies including both major and minor depression populations, the odds of identifying depression were 45.4% and 119.9% higher during pregnancy and the postpartum period, respectively compared to studies including only the MDD group.
On the other hand, the review also points out the difficulties in estimating MDD prevalence for low and middle-income countries (LMIC) due to the limited use of diagnostic interviews, which is the gold standard for correction factors in this review, and the potential lack of cultural sensitivity of symptom scales used in LMIC studies. These have posed questions about the cross-national validity of MDD prevalence during the perinatal period found in this review.
Conclusions
The study found a lower MDD prevalence rate compared to previous studies, which reveals a potential overestimation of MDD prevalence in existing literature due to inconsistencies in estimate methods, due to inconsistent definitions of MDD, use of symptom scales instead of diagnostic interviews, and variations in sampling strategies.
MDD prevalence is found to be the highest among the first 2 weeks of the postpartum period and remains elevated compared to during pregnancy. Prevalence is higher in LMICs compared to high-income countries. However, the validity of prevalence estimates in LMIC might be limited due to the lack of diagnostic interviews used in LMIC studies, questionable cultural validity of symptom scales and poor access to healthcare services, which limits the number of women being included in prevalence studies.
Strength and limitations
The researchers set out to accomplish this challenging task of estimating MDD prevalence during the perinatal period across different global regions. It examined studies across 90 countries, including both English and non-English studies as well as grey literature, which has guaranteed the generalizability of the prevalence rates reported, especially for non-Western countries. Also, differentiating the prevalence rates during pregnancy and the post-partum period allows clinicians to identify the crucial timing of prevention and intervention.
The review is methodologically strong, where the researchers followed the PRISMA guidelines, the gold standard for systematic review, and published the study protocol before data collection to ensure transparency. The researchers also clearly explained their study design rationale, such as expanding the DSM-5-TR definition of perinatal depression to include the period from the end of the first 4 weeks postpartum to 12 months postpartum, since it is a period without sufficient data in the evidence base. The author also set out to address the gap in the literature, such as examining measurement biases that might have been neglected by existing prevalence studies. However, in addition to measurement biases, it might be beneficial for the authors to evaluate other methodological qualities of the included studies, such as assessors’ competencies, selection biases or missing data, using well-validated quality assessing tools for systematic reviews.
On the other hand, as the authors highlighted, prevalence estimates in LMICs remain challenging. Lack of cultural inclusivity in research is a significant concern that affects the cross-national validity and generalizability of research findings. For instance, Western diagnostic tools and symptom scales for MDD during the perinatal period, which might not be culturally appropriate for women from a global majority background, are often used in prevalence estimates, as stated by the author. Previous studies have also revealed that stigma around mental health and family expectations are significant barriers for women from the global majority background during the perinatal period to seek help for mental health issues (Conneely et al., 2023). Coupled with the differences in access to healthcare systems and the lack of use of high-quality data collection methods, such as the use of diagnostic interviews, in less developed regions, the validity of prevalence estimates in this review, especially for LMICs, warrants caution.
Co-production is one way to improve the relevance and cultural validity of research. Although the authors stated that some researchers had lived experience of mental health issues, the study didn’t specifically consult people with lived experience of perinatal depression. It might be beneficial to incorporate the perspectives of people with lived experience throughout the study process to ensure the research findings are relevant and meaningful.
Two further limitations are worth noting. First, the authors themselves acknowledge that it was not possible to determine when individual cases of MDD emerged, so some cases classified as occurring during pregnancy or postpartum may actually have predated pregnancy; and specific groups at potentially higher risk, such as first-time parents, women who were pregnant during the COVID-19 pandemic, and those who experienced miscarriage or stillbirth, fell outside the scope of this review. Second, although the review defined MDD using DSM-5-TR criteria, the correction factors used to adjust for measurement bias were benchmarked against DSM-IV, since this was the version used by most included studies; this is a reasonable pragmatic choice given the available data, but it means the ‘gold standard’ used throughout the analysis does not fully match current diagnostic guidance.
Implications for practice
Consistent with existing literature, the review has shown that the MDD prevalence rate is elevated during the perinatal period. Furthermore, it reveals that the prevalence is particularly high during the early post-partum period and continues until 12 months after pregnancy. This highlights the need for more comprehensive screening, prevention and intervention of MDD for perinatal women, especially during the early postpartum period. The authors suggest MDD screening and referral pathways should be integrated into routine antenatal care visits with obstetricians and midwives during pregnancy, and into postnatal and child wellness checks during the postpartum period, rather than being confined to specialist mental health services.
The overestimation of MDD diagnosis in the existing literature due to the discrepancies in estimates between symptom scales and diagnostic interviews, inconsistent MDD definitions and the inclusion of minor depression in some studies is an important issue to be addressed. Women with different severities of depression should be able to access support from mental health services. However, a standardised diagnostic procedure of MDD during the postpartum period is essential, which will enable proper development of service pathways and tailored intervention to women with different symptom severities, including those with MDD and baby blues. It is also important for future researchers to use standardised sampling strategies and consistent MDD definitions for accurate prevalence estimates.
On the other hand, the disparity between high and low-income countries in MDD prevalence remains a significant concern, with Southern sub-Saharan Africa having a 5 times higher prevalence rate than high-income Asia Pacific. The disparity can be due to various reasons, such as different healthcare systems and available resources. A lack of diagnostic interviews used in LMICs indicates that there might be a lack of resources to conduct formal diagnostic assessments in both research and clinical services. Knowledge exchange and resource support from high-income countries to LMIC are needed to reduce the global disparity in the prevalence of postpartum depression.
Another important factor that contributes to the global disparity might be the cultural impacts on help-seeking, stigma and expectations on women and motherhood in non-Western countries. Moreover, engagement of South Asian women is less than that of other ethnic groups despite having one of the highest prevalence rates of MDD (Husain et al., 2024; see this blog). Insufficient cultural inclusivity in research processes, such as the use of Western diagnostic and treatment models, might not be able to address issues, such as stigma, that prevent ethnic minority women from accessing research or healthcare services. Development of culturally appropriate diagnostic processes and treatments is crucial to enhance the validity of prevalence estimates and reduce barriers to accessing healthcare services for women from these regions. Co-production with people from diverse cultural backgrounds and lived experiences should be encouraged to reduce cultural barriers in both research and service development.
Statement of interest
Angelica Tong has no conflicts of interest to declare.
Edited by
Dr Dafni Katsampa
Links
Primary paper
Alize Ferrari, Paul Miller, Jamileh Shadid, Ana Mantilla Herrera, Salma Ahmed, Pari Malpani, Taylor Noyes, Izumi Chihara, Theresa McHugh, Ni Gusti Ayu Nanditha, Theo Vos, Nicholas Kassebaum, M Ashworth Dirac & Damian Santomauro (2026). The global prevalence of major depressive disorder during the peripartum period: a systematic review and meta-regression. The Lancet Psychiatry.
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