Key Takeaways
Extended Takeaways
- In this treated depression cohort, postpartum depression was common despite routine care: 2,469 of 6,552 patients (37.7%) had a positive postpartum depression screen or depression ICD diagnosis within 365 days after delivery.
- Early antenatal symptom burden stratified risk in a dose-response pattern: compared with PHQ-9 < 5, mild symptoms (PHQ-9 score of 5–9) carried an aRR = 1.39; 95% CI, 1.29–1.50 for any PPD, while moderate-severe symptoms (PHQ-9 15–19) carried an aRR = 1.92; 95% CI, 1.73–2.13 and an aRR = 3.58; 95% CI, 2.77–4.61 for severe PPD.
- A prior postpartum depression history conferred added risk even among patients already selected for depression diagnosis and antidepressant treatment before pregnancy, with aRR = 1.31; 95% CI, 1.21–1.41 versus depression history without prior PPD.
- Medication course may matter clinically: stopping an antidepressant during pregnancy was associated with aRR = 1.14; 95% CI, 1.08–1.20 for overall PPD and aRR = 1.28; 95% CI, 1.01–1.49 for severe PPD, supporting careful shared decision-making before discontinuation.
- Markers of greater preconception illness intensity also identified higher-risk patients, as higher antidepressant dosing prior to the LMP was associated with aRR = 1.15; 95% CI, 1.03–1.28 for overall PPD and aRR = 1.34; 95% CI, 1.02–1.76 for severe PPD.
- Socioeconomic gradients were evident even within an insured integrated system with >98% perinatal depression screening: compared with median neighborhood income over $120,000, incomes of $60,000-$120,000 had aRR = 1.09; 95% CI, 1.02–1.18 and incomes less than $60,000 had aRR = 1.15; 95% CI, 1.04–1.27 for overall PPD.
