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Original Research Focus on Women’s Mental Health October 15, 2025

Determinants of Immediate Postpartum Anxiety and Its Association With Postpartum Depression: A Case-Control Study Nested in a Cohort

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J Clin Psychiatry 2025;86(4):25m15830

Abstract

Objective: To assess determinants of immediate postpartum anxiety (IPPA) and its association with postpartum depression (PPD).

Methods: We conducted an analysis of the Interaction Gene Environment in Postpartum Depression cohort, which is a prospective, multicenter, French cohort including 3,310 women enrolled between November 2011 and June 2016. Women completed the Hospital Anxiety and Depression Scale-Anxiety (HAD-A) at the maternity department between the second and fifth days following childbirth. IPPA was defined by HAD-A score >7, while HAD-A score >10 defined moderate to severe IPPA. Risk factors were collected. PPD was assessed prospectively at 2 months and 1 year postpartum.

Results: The prevalence of IPPA in this population was 24%, and 7.4% for severe anxiety. Factors independently associated with IPPA were found. Among women with IPPA, 31.2% developed PPD, compared to 16.9% of those without anxiety (adjusted odds ratio [aOR]=2.0; [95% CI, 1.6–2.5]). The association was stronger for early-onset PPD (aOR=2.2 [1.7–3.0]) than for late-onset PPD (aOR=1.8 [1.3–2.4]), even after adjusting on sociodemographic characteristics and history of major depressive episode before or during pregnancy. The higher the intensity of IPPA was, the higher the prevalence of PPD was.

Conclusion: IPPA has specific determinants and is associated, according to its intensity, with early-and late-onset PPD. Identifying (1) women at risk of anxiety, and thus eligible for dedicated support during pregnancy, and (2) women exhibiting anxiety during their maternity stay represent two targets to prevent the onset of PPD.

J Clin Psychiatry 2025;86(4):25m15830

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