Risk Factors for Perinatal Mental Health Disorders

This article is part of the Perinatal Mental Health series, which explores pregnancy, postpartum, and loss through a biopsychosocial and nervous system–informed lens.

What Causes Perinatal Mood Disorders?

What are the risk factors for postpartum depression and other perinatal mood disorders? Many expectant and new mothers ask why some people develop perinatal mental health challenges while others do not.

Research suggests there is no single cause. Instead, postpartum depression emerges from a convergence of biological, psychological, and social influences during pregnancy and the postpartum transition.

Hormonal and lifestyle changes plus the re-surfacing of past personal issues surrounding the emotional material of becoming a mother create a time period where women are more vulnerable to mood disorders (Ghaedrahmati et al, 2017; Kleiman & Wenzel, 2011; Kleiman, 2009; Puryear, 2007; Nonacs, 2006).

As you can see, perinatal mental health is deeply shaped by how the nervous system adapts to pregnancy, birth, and the postpartum transition. You may be interested in How Much Stress Is Too Much Stress in Pregancy as well.

Listed below are some of the commonly acknowledged risk factors for a woman to develop a perinatal mental illness. For ease of reading, they are grouped into bio/psycho/social categories, but, as you can see, there is overlap.

If you are concerned about symptoms, you can read more about the signs of postpartum depression here.

Biological and Psychological Risk Factors

• Personal history of a mental illness in her lifetime, such as depression anxiety, PTS/PTSD, OCD or bipolar disorder. These illnesses could have been diagnosed & treated or could have gone undiagnosed and left untreated.

• Prior episode of postpartum depression carries a 50% to 80% risk of developing it again with her second baby. (compared to a 10% to 20% risk without a prior episode)

• Family history of mood disorders (diagnosed or undiagnosed )

• History of premenstrual syndrome/disorder (PMDD), which suggests a heightened sensitivity to the hormonal cycle

• Heightened sensitivity to hormonal fluctuations of pregnancy and childbirth.

• Traumatic birth. Traumatic birth can occur on a continuum from disappointing care to painful natural birth to actual life threatening complications for mom and/or baby during the birth.

• Premature infant or NICU admissions can be medically and emotionally traumatic

• A history of extensive infertility treatments, trauma from repeated necessary medical procedures.

• Unresolved feelings around a previous pregnancy loss

• Unresolved feelings around a previous abortion

• Having an infant with medical complications or a disability

• Having experienced a stillbirth

Even if you have some risk factors, having early awareness, proactive planning and seeking support significantly reduces the severity and duration of postpartum mood disorders.

Social and Environmental Risk Factors

• Lack of social support due to a geographical move

• Non-supportive family structure (due to alcoholism or mental illness, etc)

• Major change in job (ie, from career to SAHM, so the friend network is disrupted).

• Partner issues: lack of communication, differences in parenting styles, general disconnects

• Financial difficulties in the marriage/partner relationship

• Poverty is a high risk factor

• An abusive relationship – verbally, emotionally, physically abusive - which can be causal to a complex history of trauma/PTS/PTSD

• Personal history of sexual abuse or sexual assault - which can be causal to a complex history of trauma/PTS/PTSD.

• Unresolved issues from childhood regarding parenting

• Family issues such a an accident or death

  
  

Highest Risk Factors for Postpartum Depression

Research consistently identifies several high-impact risk factors for postpartum depression and other perinatal mood disorders:

• Previous depression or anxiety

• Traumatic or chaotic childhood experiences (family history of alcoholism, addiction, mental illness, rage, physical and verbal abuse)

• Current poverty

• Lack of social support

  
  

While these risk factors increase vulnerability, postpartum depression is treatable — and early awareness allows families to seek support proactively.

Preparing Proactively: Reducing Risk

Understanding risk factors does not mean postpartum depression is inevitable. It means families can plan intentionally and seek support early.

Proactive steps include:

• Create a thoughtful Fouth Trimester Plan

• Consciously build a broader social support network

• Reach out to one or two close friends and family.

• Arrange meal support and/or food delivery

• Make and freeze casseroles now.

• Prioritize sleep and physical health (short walks, mindfulness, meal planning)

• Prioritize mental health. If you need to talk to a professional therapist, start the search for a compatible one now.

• If appropriate, consult with a medical provider about medication.

There's a growing body of research supporting the safety of certain psychotrophic medications during pregnancy and breastfeeding. A trusted resource for evidence-based detailed information is Mother to Baby.

Help Is Available

If you are experiencing symptoms of postpartum depression, anxiety, or other perinatal mood disorders, support is available. You are not alone, and effective treatment exists.

Postpartum Support International (PSI) offers a confidential helpline, online support groups, and local provider referrals for families during pregnancy and the postpartum period.

Call or text 1-800-944-4773 (EN/ES) or visit postpartum.net to find support in your area.

If you are in immediate crisis, call or text 988 in the United States.

References

Ayers, S. and Ford, E. (2009). Birth trauma: Widening our knowledge of postnatal mental health. European Health Psychologist, June, 2009, (11), p. 16 – 20.

Driscoll, D. and Sichel, J. (1999). Women’s moods: What every woman must know about hormones, the brain, and emotional health. New York: HarperCollins

Ghaedrahmati, M., Kazemi, A., Kheirabadi, G., Ebrahimi, A., & Bahrami, M. (2017). Postpartum depression risk factors: A narrative review. Journal of education and health promotion, 6, 60. https://doi.org/10.4103/jehp.jehp_9_1

Kleiman, K. (2009). Therapy and the postpartum woman. New York: Routledge Press.

Nonacs, R. (2006). A deeper shade of blue. New York: Simon and Schuster.

Puryear, L. J. (2007). Understanding your moods when you’re expecting. New York: Houghton Mifflin Company.

Zeng, Y., Cui, Y. & Li, J. Prevalence and predictors of antenatal depressive symptoms among Chinese women in their third trimester: a cross-sectional survey. BMC Psychiatry15, 66 (2015). https://doi.org/10.1186/s12888-015-0452-7