# Risk factors for postpartum depression after cesarean section: a systematic review and meta-analysis

## TL;DR

This study identifies key risk factors for postpartum depression after cesarean delivery, including age, first-time pregnancy, education level, and antenatal mental health.

## Contribution

The study provides a meta-analysis of risk factors for postpartum depression after cesarean delivery to inform clinical prevention strategies.

## Key findings

- Younger age is associated with increased risk of postpartum depression after cesarean delivery.
- Higher antenatal depression and anxiety scores are significant risk factors for postpartum depression.
- First-time pregnancy and lower education level increase the likelihood of postpartum depression after cesarean section.

## Abstract

The incidence of cesarean section (CS) is increasing each year and may be associated with an increased risk of postpartum depression (PPD). Although studies have examined the association between cesarean delivery and postpartum depression, the associated risk factors have not been fully investigated. This study aims to identify key risk factors for planned and emergency cesarean delivery through meta-analysis to help develop clinical prevention strategies.

We searched multiple databases, including CNKI, Wan Fang, VIP, PubMed, Embase, Scopus, Google Scholar, CINAHL, Cochrane Library, and Web of Science, for studies published from the inception of these databases through January 8, 2025. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS), and standardized mean difference (SMD) and ratio of ratios (OR) were used to assess the strength of association between different risk factors and postpartum depression, when I2 > 50%, a random effects model was used for data analysis; when I2 < 50%, a fixed effects model was chosen for analysis.

Nine articles (n = 3,338) were included in this study, meta-analysis results suggest that younger women (SMD = −0.16, 95% CI [−0.29 to −0.04], I2 = 0%), higher antenatal depression scores (SMD = 0.28, 95% CI [0.13–0.44], I2 = 15.1%), higher antenatal anxiety scores (SMD = 0.56, 95% CI [0.40–0.72], I2 = 35.6%) are more likely to experience postpartum depression, nulliparous (OR = 1.9, 95% CI [1.39–2.60], I2 = 0%) and elementary education level (OR = 1.34, 95% CI [1.05–1.72], I2 = 44.3%) were risk factor for postpartum depression after caesarean section.

In summary, age, first-time pregnancy status, education level, and antenatal depression and anxiety scores are important risk factors for postpartum depression following cesarean delivery. Identifying and addressing these factors could provide valuable insights for the prevention and management of postpartum depression.