In the world, one in every 15 women experiences a major depressive disorder within a year after giving birth. This figure confirms that perinatal depression is a significant public health issue. It is not just a temporary low mood, but a serious condition that affects the mother's daily life, her relationship with the baby, and the overall well-being of the family.

An important systematic review was published in The Lancet Psychiatry journal, detailing how and when major depression occurs from pregnancy to the first 12 months postpartum. Data covering more than two million women from 90 countries shows that the risk peaks not only during pregnancy but also in the first two weeks after birth and remains high throughout the first year.

One in every 15 women experiences postpartum major depression

The study presents clear figures on the global prevalence of major depressive disorder (MDD) during the perinatal period: approximately 6.2% of women experience this disorder during pregnancy, and an increase of about 6.8% is observed within the year following childbirth. This means that one in every 16 pregnant women and one in every 15 new mothers faces a clinically significant depressive condition.

Contrary to past beliefs, perinatal major depression is not limited to the first few days after birth. The study confirms that the prevalence is higher in the first two weeks postpartum, affecting approximately 8.3% of the women, and these rates remain elevated throughout pregnancy and the baby's first year.

Major depressive disorder is different from postpartum sadness or baby blues, which is a mild and temporary mood condition experienced by many women in the first days after childbirth. In major depression, symptoms are more intense and persistent: deep sadness, loss of interest in activities that were previously enjoyable, feelings of inadequacy in coping with daily life, extreme fatigue, and in some cases, recurring negative thoughts.

According to the authors, these findings correct previous estimates that perinatal depression was between 14% and 17%; these figures are now considered inflated due to methodological issues. The new review more accurately reflects the true situation by making a clear distinction between mild emotional changes and the clinical diagnosis of major depressive disorder.

A global study covering more than two million women

This research is part of the Global Burden of Disease Study (GBD) and is led by Dr. Alize J. Ferrari from the University of Queensland, Australia. To generate these estimates, the team reviewed 780 studies covering more than two million women and adolescents aged 10 to 59 from 90 countries.

The aim was twofold: on one hand, to calculate the prevalence of major depressive disorder during pregnancy, the pre- and postnatal period, and the baby's first year; on the other hand, to analyze how depression was measured in previous studies, comparing screening questionnaires with full clinical diagnoses.

One of the key findings is that symptom-based screening tools, such as the Edinburgh Postnatal Depression Scale (EPDS) or the PHQ-9 questionnaire, tend to inflate the prevalence of major depressive disorder. According to the review, such tools can increase figures by 71% to 122% compared to a structured diagnostic interview conducted by a mental health professional.

This finding does not mean that questionnaires are not useful, but it emphasizes that they need to be interpreted carefully. The authors stress that scales should be validated in each cultural context and, when necessary, should be followed up with a more comprehensive clinical assessment.

Dr. Ferrari and his team emphasize that accurately understanding the scope of perinatal depression is key to planning resources, prioritizing interventions, and assessing development over time. By adapting to more robust diagnostic methods, the study provides a more reliable foundation for the design of maternal mental health policies.

Regional differences: Focus on Europe and global comparison

The analysis also highlights the significant geographical differences in perinatal depression. Rates are not uniform across all regions and appear to be closely tied to socioeconomic factors, structural inequalities, and access to healthcare.

In Western Europe, in the region that includes Spain, the review shows the prevalence of major depressive disorder during pregnancy to be around 5.0% and between 5-5.5% within the first year postpartum. These figures are below the global average but still higher compared to the overall female population in these regions.

In stark contrast, the highest rates are recorded in Sub-Saharan Africa, where the proportion of affected women during pregnancy is 15.6% and 16.6% in the 12 months following childbirth. On the other hand, high-income regions of the Asia-Pacific have the lowest prevalence rates, with 3.1% during pregnancy and 3.3% postpartum.

In North America, the figures are approximately 4-4.6% for both pregnancy and postpartum periods; this is slightly below the figures for Western Europe. These differences indicate that the economic and social context, the existing support networks, and the organization of healthcare systems significantly influence the risk of developing perinatal depression.

The authors of the study believe that these findings support the necessity for prevention and treatment strategies that will adapt to each regional reality. In environments where health resources are scarcer or where greater inequalities exist, mothers may be more exposed to factors such as stress, violence, or economic insecurity, which can increase the risk of major depressive disorder.

Impact on mother, baby, and family

The review highlights that major depression during pregnancy and the postpartum period has a deep and lasting impact on women's lives. Beyond intense sadness or lack of energy, many mothers report difficulties in bonding with the baby, feelings of guilt or worthlessness, sleep problems, and changes in appetite.

These challenges not only affect the mother's health. Scientific evidence shows that untreated perinatal depression can affect early bonding with the newborn, impact the child's emotional development, and create a climate of tension or conflict within the family environment. All of these can prolong suffering that lasts beyond the baby's first year.

Perinatal mental health experts have repeatedly stated that pregnancy and postpartum periods are times of higher psychiatric sensitivity compared to other life stages. The Lancet study shows that the risk of major depressive disorder remains high for months and is not limited to a brief postpartum episode.

Professor Emma Motrico from the Department of Developmental Psychology and Education at the University of Seville and a researcher at the Seville Biomedical Institute (IBIS) views the results as confirmation that depression is present throughout pregnancy, noting that it "peaks two weeks after childbirth and continues throughout the first year postpartum." This creates a particularly challenging impact for the mother, baby, and their surroundings.

In this context, experts remind us that detection, emotional support, and treatment when necessary can make a difference between a motherhood process filled with intense pain and a process where women feel supported and cared for despite the challenges.

What do experts in Spain say about perinatal care?

In the Spanish context, various experts consulted by scientific platforms such as SMC Spain agree that the data from the review should serve as a call to attention for health systems. Professor Emma Motrico emphasizes the methodological quality of the study and points out that the screening tools used in daily clinical practice need to be improved.

Motrico notes that while common surveys can be useful as an initial approach, they tend to inflate the number of depression cases. According to her, it is ideal for these tools to be integrated into broader protocols with clinical assessments conducted by professionals specifically trained in structured interviews and perinatal mental health.

Among the recommendations is the full integration of mental health into obstetric services: from pregnancy check-ups to postpartum follow-up, including care in delivery services and health centers. This will require the establishment of clear referral pathways, scheduling psychological assessments at critical moments, and providing support resources to mothers in need.

Psychiatrist Eduard Vieta, head of the Psychiatry Service at Barcelona Clinical Hospital and a CIBERSAM researcher, reminds us that pregnancy is a period of higher psychiatric risk and complains about the inadequacy of specific programs to address these issues in Spain. He points out that many women do not receive holistic care to maintain both their emotional well-being and their bond with the newborn.

Vieta emphasizes that establishing a secure attachment relationship in the early months is "vital" for the child's future emotional development. Therefore, he states that the treatment of perinatal depression should not be limited to addressing the mother's symptoms but should also focus on preserving the mother-baby relationship and providing support to the family as a whole.

Progress for perinatal care that includes mental health

The Lancet's review reinforces the idea that perinatal mental health should be systematically integrated into pregnancy, childbirth, and postpartum services. The authors advocate for the implementation of clear protocols that define how, when, and with which tools to screen for major depression during pregnancy and the postpartum period.

Among the proposed lines of action is the development of evidence-based clinical practice guidelines; these guidelines should guide obstetric specialists, midwives, pediatricians, family doctors, and mental health professionals in identifying and managing these cases. These guidelines should encompass everything from prevention and health education measures to psychological treatment and pharmacological treatment when necessary.

Experts also emphasize the importance of adapting these recommendations to the characteristics of each country or region. In Spain and Western Europe, since the rates are moderate but high enough to not be ignored, strengthening the coordination between Primary Health, mental health, and maternity services could be particularly beneficial; thus, women will not get lost between services.

Another highlighted issue is the specialized training of professionals. Having health personnel who can recognize warning signs, distinguish a temporary emotional disturbance from major depressive disorder, and provide information to mothers without stigma or bias is a key element for women to express their experiences.

Additionally, there is evidence that the presence of social and family support, mother groups, and accessible community resources can function as protective factors. In this context, the authors of the study and the consulted experts agree that public policies should support measures that facilitate reconciliation, reduce insecurity, and promote safer parenting environments.

Overall, new data confirms that major depression is a common, inadequately addressed issue with significant consequences during pregnancy and within the first year postpartum, but it also shows that it is an area with great potential for improvement. One in every 15 women faces this disorder, and providing more accurate diagnoses, specialized resources, and perinatal care that includes mental health can make a difference between going through this process alone and going through it with appropriate support and treatment.