Prevalence of postpartum depression in the COVID-19 pandemic and associated factors: systematic review and meta-analysis

TL;DR

This study finds that postpartum depression rates increased during the COVID-19 pandemic, with regional differences and new risk factors emerging.

Contribution

The study provides a global meta-analysis of postpartum depression during the pandemic, identifying new and pre-existing risk factors.

Findings

The global prevalence of postpartum depression during the pandemic was 28.48%.

Higher rates were observed in Latin America and in countries with lower HDI and higher gender inequality.

PPD rates increased with postpartum time, reaching 36.55% at 12 months postpartum.

Abstract

The COVID-19 pandemic created a disruptive scenario with an increase in the prevalence of postpartum depression (PPD) and new associated risk factors, which deserve to be better studied, in different global contexts, which led to the present systematic review study.

Observational studies published in English, Portuguese, and Spanish between 2020 and 2025 were included, and a meta-analysis was conducted using a random-effects model.

An initial survey of 1741 articles, of which 90 studies were selected with a total of 64,6994 women evaluated for PPD, with a range between 50 (1) and 5,134 (2) women. The overall prevalence of postpartum depression during the COVID-19 pandemic was 28.48% (25.14—31.94), with rates of 23.52% (18.961—28.40) in studies that used the Edinburgh Postnatal Depression Scale (EPDS) as a diagnostic instrument with a cutoff point ≥ 13. Studies from 31 countries were included, with higher prevalence observed in Latin America (34.08%), with lower rates in Europe (31.50%), the Middle East (29.31%), USA/Canada (24.26%), and Asia (22.32%). There was a higher prevalence of PPD in countries with a lower Human Development Index (HDI) (30.95%), with higher COVID-19 CFR (32.56%), higher maternal mortality (30.43%); and with the highest Gender Inequality Index (GII) (35.41%). PPD rates increased with postpartum time, varying between 18.31% (up to 1 month), 20.78% (up to 3 months), 34.67% (up to 6 months) and 36.55% (up to 12 months). Additionally, 11 protective factors and 53 risk factors were identified, most related to the pandemic, but also with the presence of factors already consolidated in the literature before the pandemic.

There was a global increase in the prevalence of PPD during the pandemic, with an intensification of pre-existing regional differences, causing the impact of the pandemic to be different according to the region.

The social and health crisis of the pandemic negatively impacted postpartum mental health, with significant regional differences.

The study was registered in PROSPERO with the code CRD42023392973.

The online version contains supplementary material available at 10.1186/s12884-025-08262-z.

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