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Clinical Psychiatry
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The Journal of Clinical Psychiatry

Original Research Focus on Women’s Mental Health June 17, 2026

Race, Ethnicity, Socioeconomic Status, Clinical Characteristics, and Postpartum Depression in Patients With a History of Depressive Episodes

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J Clin Psychiatry 2026;87(3):24m15711

Mother and newborn in nursery, highlighting postpartum depression concerns

Abstract

Objective: The objective was to identify demographic and clinical characteristics associated with postpartum depression (PPD) risk in patients with depressive disorder histories.

Method: This retrospective cohort study used electronic health records from a US health care system including patients aged ≥18 years with a live birth and International Classification of Diseases (ICD)–coded depression in the year before their last menstrual period between January 1, 2010, and December 31, 2019. Modified Poisson regression evaluated associations, with PPD defined as an ICD code or a Patient Health Questionnaire-9 (PHQ-9) score of ≥10 in the year after delivery. A PHQ-9 score of ≥20 defined severe PPD.

Results: Of 6,552 patients, 37.7% screened positive for PPD. Asian/Pacific Islander, Black, and LatinX patients had significantly higher PPD risk (adjusted risk ratio [aRR] = 1.54; 95% CI, 1.18–2.01; aRR= 1.65; 95% CI, 1.25–2.17; and aRR= 1.29; 95% CI, 1.06–1.58, respectively, for severe symptoms). Patients with low median incomes (aRR= 1.33; 95% CI, 1.02–1.73) or Medicaid insurance (aRR= 1.09; 95% CI, 1.02–1.28) had higher PPD risk. Higher antidepressant dosing before pregnancy, PPD history, stopping antidepressants during pregnancy, and moderate-severe depressive symptoms early in pregnancy were associated with severe PPD risk (aRR= 1.34; 95% CI, 1.02–1.76; aRR= 1.31; 95% CI, 1.21–1.41; aRR = 1.14; 95% CI, 1.08–1.20; aRR= 3.58; 95% CI, 2.77–4.61, respectively). Higher parity was associated with lower PPD risk (aRR=0.90; 95% CI, 0.84–0.98 for 1 and aRR =0.90; 95% CI, 0.83–0.99 for 2+). Age, multiple gestations, or delayed prenatal care start were not associated with risk.

Conclusions: Patients with a depressive disorder history have specific characteristics associated with PPD risk, which differ from the general pregnant population. These findings can help improve PPD screening and personalized care delivery.

J Clin Psychiatry 2026;87(3):24m15711

Author affiliations are listed at the end of this article.

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