# Postpartum Depressive Symptoms and Their Long-Term Association with Anxiety and Depression in Women: Findings from the Rhea Study in Crete, Greece

## TL;DR

Women with postpartum depression are more likely to experience anxiety and depression 11 and 15 years later, with anxiety risks increasing over time.

## Contribution

This study reveals that postpartum depressive symptoms predict long-term mental health issues, particularly stronger anxiety risks over time.

## Key findings

- Higher postpartum depressive symptoms are linked to greater anxiety and depression symptoms 11 and 15 years later.
- The association between postpartum depression and anxiety becomes stronger over time, especially at 15 years postpartum.
- Postpartum depression serves as an early indicator of long-term vulnerability to mood and anxiety disorders.

## Abstract

What are the main findings?
Postpartum depressive symptoms are associated with higher levels of depression and anxiety symptoms 11 and 15 years after childbirth.The link between postpartum depressive symptoms and anxiety strengthens over time, with a stronger association observed at the 15-year follow-up.

Postpartum depressive symptoms are associated with higher levels of depression and anxiety symptoms 11 and 15 years after childbirth.

The link between postpartum depressive symptoms and anxiety strengthens over time, with a stronger association observed at the 15-year follow-up.

What are the implications of the main findings?
Early postpartum depressive symptoms are associated with an increased likelihood of elevated depressive and anxiety symptoms later in life.There is a need for early screening and long-term support for mothers to mitigate the risk of enduring psychological difficulties.

Early postpartum depressive symptoms are associated with an increased likelihood of elevated depressive and anxiety symptoms later in life.

There is a need for early screening and long-term support for mothers to mitigate the risk of enduring psychological difficulties.

Background/Objectives: Postpartum depression affects 10–20% of women and may have long-term consequences for mental health. This study examines the association between postpartum depressive symptoms and women’s depression and anxiety symptoms 11 and 15 years after childbirth. Methods: Data were drawn from the Rhea Mother–Child Cohort in Crete, Greece. A total of 1079 women completed the Edinburgh Postnatal Depression Scale (EPDS) at approximately 8–10 weeks postpartum. Of these, 516 participated in follow-up assessments at 11 and 15 years, which included measures of anxiety (State-Trait Anxiety Inventory, Trait version [STAI-Trait]) and depressive symptoms (Beck Depression Inventory [BDI]). Multivariable linear mixed-effects models were used to assess the relationship between postpartum depressive symptoms (EPDS) and later anxiety (STAI-Trait) and depression (BDI) outcomes, adjusting for sociodemographic and family-related characteristics and psychosocial factors. Results: Higher postpartum EPDS scores were associated with greater anxiety (STAI-Trait) and depressive symptoms (BDI) across follow-up assessments. Associations remained significant after adjusting for maternal baseline characteristics and follow-up factors. An interaction with time suggested that the association between postpartum depressive symptoms and anxiety levels strengthened over time, with a stronger association at the 15-year follow-up, indicating a higher long-term mental health burden. Conclusions: Postpartum depressive symptoms are associated with higher levels of depressive and anxiety symptoms 11 and 15 years after childbirth. The association with depression appeared relatively consistent across follow-up assessments, while the relationship with anxiety was stronger at the 15-year follow-up. These findings suggest that postpartum depression is an early marker of long-term vulnerability to mood and anxiety disorders, highlighting the importance of early screening, intervention, and long-term mental health support for mothers to reduce the risk of enduring psychological difficulties.