The Invisible Side of Motherhood: Depression and Psychosis Increase After Childbirth

This large study of nearly 1.8 million pregnancies in Sweden showed that the risk of mental disorders is generally lower during pregnancy, but increases significantly in the weeks following birth for depression and psychosis. The research highlights the importance of maternal psychological monitoring in the postpartum period.

Maternal mental health is a crucial public health issue, as it influences not only long-term psychological well-being but also the immediate physical health and quality of life of the family.

Several studies show that mental health problems during or after pregnancy increase the risk of autoimmune diseases, cardiovascular diseases, hormonal disorders, suicidal behavior, and even early death. Therefore, understanding when and how these disorders appear around pregnancy is essential for developing prevention and treatment strategies.

Pregnancy and the postpartum period represent phases of profound biological and emotional change. The body undergoes intense hormonal changes, adjustments to the immune system, and metabolic changes. At the same time, the body adapts to a new family life and the responsibilities of motherhood.

These transformations, combined, make women more vulnerable to developing psychiatric disorders such as depression, anxiety, bipolar disorder, eating disorders, substance abuse, stress-related disorders, and, in more severe cases, psychosis.

While it is known that depression is relatively common after pregnancy, information on the frequency and timing of different disorders remains limited. Many previous studies have only compared pre- and post-pregnancy outcomes, but have not thoroughly evaluated the gestational period.

Furthermore, most have not considered primary care visits, where many mild to moderate cases are identified, focusing solely on hospital admissions or specialist diagnoses.

This study, conducted in Sweden, sought to fill this gap. Researchers analyzed national and regional medical records of all women who gave birth in the country between 2003 and 2019, corresponding to nearly 1.8 million pregnancies. The strength of this study lies in its scale and scope: both primary care and specialist visits were included, allowing for a much more realistic view of the situation. The scientists divided the mothers' follow-up into three distinct periods:

• Preconception year: the 12 months before pregnancy.

• Pregnancy: the 9 months of gestation.

• Postpartum year: the 12 months after birth.

They recorded all new diagnoses of psychiatric disorders and calculated the frequency of these illnesses each week and year, standardizing the data by age and historical period. They also compared the risks of developing each disorder over time, using the preconception period as a reference.

The results showed a clear pattern. Overall, the risk of developing a psychiatric disorder was stable before pregnancy (approximately 25 cases per 1,000 women per year). During pregnancy, this rate decreased significantly, reaching 4 cases per 1,000. After delivery, the risk returned to the same level as before pregnancy.

However, two disorders stood out: depression and psychosis, which increased significantly in the first few weeks after delivery (between the 5th and 15th week for depression and between the 0th and 20th week for psychosis). This shows that the period immediately after birth is a window of greatest vulnerability.

In summary, the research reveals that, although pregnancy itself appears to be associated with a lower risk of mental disorders, the postpartum period is a critical period for the emergence of depression and psychosis. These findings reinforce the need for targeted medical attention immediately after birth, not only for the physical health of the baby, but also for the mental health of the mother.

READ MORE:

Maternal psychiatric disorders before, during, and after pregnancy: a national cohort study in Sweden

Emma Bränn, Jerry Guintivano, Yihui Yang, Louise Lundborg, Marion Opatowski, Fang Fang, Unnur A. Valdimarsdóttir, Emma Fransson, Alkistis Skalkidou, Yi Lu, and Donghao Lu 

Molecular Psychiatry. (2025)

https://doi.org/10.1038/s41380-025-03212-9

Abstract: 

Maternal mental health is a critical public health issue, yet the evidence on rates of incident psychiatric disorders before, during, and after pregnancy is limited. This study aimed to describe the calendar time trends and characterize and compare the risk of maternal psychiatric disorders before, during, and after pregnancy. Leveraging the national and regional registers in Sweden, we conducted a cohort study of all women who gave birth 2003–2019 in Sweden (1,799,010 pregnancies from 1,052,977 women). We identified any incident diagnosis of psychiatric disorders recorded during three periods: the preconceptional year, pregnancy, and the postpartum year. We calculated age and calendar year standardized incidence rate (SIR) of psychiatric disorders annually, and by week across three periods. We further estimated the incidence rate ratio (IRR) using the rate during corresponding preconceptional weeks as the reference. The SIR of maternal psychiatric disorder overall increased from 2003–2019, especially for preconceptional disorders. During the preconceptional year the weekly SIR of any psychiatric disorder was stable at around 25 per 1000 person-years. The SIR gradually decreased during pregnancy to a minimum of 4 per 1000 person-years and bounced back to the preconceptional levels during the postpartum year. This trend was similar in all subtypes of psychiatric disorders, except for depression and psychosis for which an increase was noted at 5–15 and 0–20 postpartum weeks, respectively. An increased incidence rate of maternal psychiatric disorder diagnosed before, during, and after pregnancy was found over time. Our findings suggest an increased risk of depression and psychosis shortly after delivery, although a lowered risk of other psychiatric disorders during and after pregnancy, compared to before pregnancy.