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. 2022 Aug 17;79(10):1004–1013. doi: 10.1001/jamapsychiatry.2022.2400

Family History of Psychiatric Disorders as a Risk Factor for Maternal Postpartum Depression

A Systematic Review and Meta-analysis

Mette-Marie Zacher Kjeldsen 1,2,✉, Alessio Bricca 3,4, Xiaoqin Liu 1, Vibe G Frokjaer 5,6,7, Kathrine Bang Madsen 1, Trine Munk-Olsen 1,8
PMCID: PMC9386615  PMID: 35976654

Key Points

Question

Is the risk of developing postpartum depression higher for mothers with a family history of psychiatric disorders than mothers without?

Findings

In this systematic review and meta-analysis comprising 26 studies from 5 continents totaling 100 877 women, the risk of developing postpartum depression was almost twice as high among mothers who had a family history of psychiatric disorders compared with mothers without a family history.

Meaning

Family history of psychiatric disorders is a strong risk factor for postpartum depression, which ideally can be identified through self-report already during pregnancy and enable timely and targeted preventive initiatives.

This systematic review and meta-analysis investigates the association between family history of psychiatric disorders and risk of developing postpartum depression within 12 months post partum.

Abstract

Importance

Current evidence on the association between family history of psychiatric disorders and postpartum depression is inconsistent; family studies have identified familial risk of postpartum depression, whereas systematic reviews and umbrella reviews, compiling all risk factors for postpartum depression, often have not.

Objective

To investigate the association between family history of psychiatric disorders and risk of developing postpartum depression within 12 months post partum.

Data Sources

Literature searches were conducted in PubMed, Embase, and PsycINFO in September 2021 and updated in March 2022, accompanied by citation and reference search.

Study Selection

Studies eligible for inclusion comprised peer-reviewed cohort and case-control studies reporting an odds ratio (OR) or sufficient data to calculate one for the association between family history of any psychiatric disorder and postpartum depression. Study selection was made by 2 independent reviewers: title and abstract screening followed by full-text screening.

Data Extraction and Synthesis

Reporting was performed using the MOOSE checklist. Two reviewers independently extracted predefined information and assessed included studies for risk of bias using the Newcastle-Ottawa Scale. Data were pooled in a meta-analysis using a random-effects model. Heterogeneity was investigated with meta-regression, subgroup, and sensitivity analyses. Publication bias was investigated using a funnel plot, and GRADE (Grading of Recommendations Assessment, Development, and Evaluation) was used to evaluate the overall certainty of the findings.

Main Outcomes and Measures

The primary outcome was the pooled association between family history of psychiatric disorders and postpartum depression.

Results

A total of 26 studies were included, containing information on 100 877 women. Meta-analysis showed an increased OR of developing postpartum depression when mothers had a family history of psychiatric disorders (OR, 2.08; 95% CI, 1.67-2.59; I2 = 57.14%) corresponding to a risk ratio of 1.79 (95% CI, 1.52-2.09), assuming a 15% postpartum depression prevalence in the general population. Subgroup, sensitivity, and meta-regression analyses were in line with the primary analysis. The overall certainty of evidence was deemed as moderate according to GRADE.

Conclusions and Relevance

In this study, there was moderate certainty of evidence for an almost 2-fold higher risk of developing postpartum depression among mothers who have a family history of any psychiatric disorder compared with mothers without.

Introduction

The postpartum period is critical for mothers, children, and families, and approximately 10% to 15% of new mothers experience postpartum depression (PPD),1,2 one of the most common complications related to childbirth.3 PPD ranges from mild to severe episodes and includes similar symptoms as major depression outside the postpartum period.3 PPD is preventable and treatable, and therefore, early identification of women at high risk is important to prevent or mitigate the detrimental consequences observed in relation to PPD.4,5,6

Several risk factors for PPD have been identified and summarized in systematic reviews; however, having a relative with a psychiatric disorder is often not listed as a risk factor in reviews summarizing all identified risk factors.7,8,9,10,11,12,13,14,15,16,17,18 Recently, 3 comprehensive umbrella reviews, compiling evidence from several systematic reviews on risk factors for PPD, also did not identify family history of psychiatric disorders as a risk factor.19,20,21 The few systematic reviews that have identified family history of psychiatric disorders as a risk factor have predominantly been based on a few primary studies, are often cross-sectional or with small effect sizes, and have inconsistent findings.22,23,24,25,26,27 In contrast, familiality of PPD has been found in observational family studies,28,29,30 where greater heritability of PPD than major depressive disorders has been reported.31 This is directly in line with the research on familial risk of mental disorders outside the postpartum period consistently showing high heritability of psychiatric disorders.32,33,34,35 It is therefore puzzling why family history of psychiatric disorders is not identified as a risk factor in several reviews focused on all PPD risk factors, when evidence from research in psychiatry outside the post partum strongly suggests so.

The primary objective of this systematic review and meta-analysis was to summarize the current literature on the association between family history of psychiatric disorders and PPD with an onset of 0 to 12 months post partum. The second objective was to investigate whether the association was modified by different assessment points and definitions of family history of psychiatric disorders and PPD.

Methods

This review and meta-analysis was conducted following the Cochrane Handbook recommendations and reported according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline (eMethods 1 in the Supplement).36,37 The protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols (PRISMA-P) reporting guideline,38 registered in PROSPERO on September 10, 2021,39 and published in a peer-reviewed journal.40 See eMethods 2 in the Supplement for specifications to the protocol.

Eligibility Criteria, Data Sources, and Search Strategy

Cohort and case-control studies investigating family history of psychiatric disorders as a risk factor for PPD within 12 months post partum were eligible. Family history of psychiatric disorders was defined as any psychiatric disorder among close and extended family members obtained through registers, validated instruments, or self-reported data. PPD was defined through registers (prescribed medications for depression treatment; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] codes F32, F33, and F34.1; or equivalent DSM-IV and DSM-5 minor and major depression), clinical interviews, or validated instruments. To ensure temporality, in cohort studies, information on family history of psychiatric disorders had to be collected prior to PPD. For case-control studies, information on family history of psychiatric disorders should not be self-reported if collected at the same time as PPD. Furthermore, eligible studies had to present either an odds ratio (OR) for the association or sufficient data to estimate an OR, and reporting had to be distinct for the postpartum period. Finally, only peer-reviewed English, Norwegian, Swedish, Danish, and Italian articles were included.

Searches were performed without language or year of publication restriction in PubMed, Embase, and PsycINFO on September 12, 2021, accompanied by reference screening and citation tracking in Web of Science. The search was updated on March 31, 2022, before finalizing the review. See the protocol for search strings and construction of them.40

Selection Process and Data Extraction

Records from the database searches were imported to EndNote, where duplicates were removed. Afterward, records were imported to an online tool, Covidence, used in the first part of the screening process.41 The screening process was undertaken by 2 independent reviewers (M.-M.Z.K. and K.B.M.) and performed in 2 steps; title and abstract screening followed by full-text screening. When disagreement occurred during the title and abstract screening, those studies were referred to full-text screening. When disagreement occurred in the full-text screening, 2 other reviewers (X.L. and T.M.-O.) were consulted. Explanations for the exclusion of each article during full-text screening were filled into the PRISMA flowchart. To ensure similar selection, a training exercise was completed before initiating the screening process; the 2 reviewers each evaluated the first 50 articles and discussed disagreements.

In case of articles with missing ORs or insufficient data to estimate an OR, the authors were contacted up to 3 times to obtain the missing information before exclusion. See the protocol for elaboration.40 If the study population was already included in the review, the authors of the identified article were not contacted to avoid double counting in the meta-analysis. Articles fulfilling all criteria for inclusion were included irrespective of whether the study sample was already used in another included article, but only the study with the largest population size was included in the meta-analysis. Data extraction was conducted independently by 2 reviewers (M.-M.Z.K. and K.B.M.) and filled into a predefined Excel form (Microsoft). See the protocol for more information.40

In articles presenting more than 1 risk estimate for different types of family history of psychiatric disorders, decision on which one to extract was undertaken in 2 steps: if presenting a broad definition, eg, family history of mental disorders, this was extracted. If no broad definition was presented, the ICD-10 inbuilt hierarchy guided the decision with extraction of the most severe type of psychiatric disorder.42

A training session was held before data extraction; both reviewers extracted data from the first 5 articles and compared and discussed. After the exercise, both reviewers independently extracted data from the rest of the articles before comparing and discussing disagreements.

Risk of Bias Assessment

The Newcastle-Ottawa scale was used to assess risk of bias in all included studies. Both reviewers independently assessed each study and discussed disparities. The scale has been developed for assessing case-control and cohort studies and consists of 8 items awarding studies of the highest quality with a maximum of 9 stars, with higher scores representing lower risk of bias.43 For elaboration and individual risk of bias scores, see eMethods 3 in the Supplement.

Data Synthesis and Statistical Analysis

Meta-analyses were performed using a random-effects model with restricted maximum likelihood given the expected heterogeneity of the samples and PPD definitions, using the Meta command in Stata version 17.0 (StataCorp). When a study reported both unadjusted and adjusted ORs, both were extracted, but the adjusted estimate was included in the primary analysis, and both estimates were used in sensitivity analyses comparing adjusted ORs against unadjusted ORs. If reporting of estimates at different time points post partum were reported, all estimates were extracted and used in the secondary analysis stratified on PPD assessment time. Only the estimate closest to birth was used in the primary analysis. Statistical heterogeneity between studies was estimated with Q test and presented through I2.

The primary analysis focused on the pooled association between family history of psychiatric disorders and PPD. Secondary analyses were performed to investigate the association stratified on assessment time of PPD and definitions of family history of psychiatric disorders and PPD.

Subgroup analyses were conducted on study design, geography, sample type, and cumulative and point prevalence estimates. Sensitivity analysis was conducted on unadjusted and adjusted estimates and excluding studies with high risk of bias (eMethods 3 in the Supplement). Meta-regression analyses were performed to examine the influence of participant characteristics (age, primiparity, personal depression history, and personal psychiatric history) and risk of bias on the pooled ORs. Publication bias was investigated by visual inspection of the funnel plot44 and the Peters test.37,45

Quality of Evidence

GRADE (Grading of Recommendations Assessment, Development, and Evaluation) for prognostic studies was used to evaluate the overall certainty of the findings.46 GRADE is a systematic approach to assess the certainty of evidence by assessing 5 domains: methodological flaws of the studies (eg, risk of bias), heterogeneity of results across studies (eg, inconsistency), generalizability of the findings (eg, indirectness), precision of the estimates, and risk of publication bias.46 The certainty in the overall estimate can be rated in 4 categories, ranging from high to very low.

Results

Search Results

The database search retrieved 4239 articles, of which 1122 were excluded as duplicates and 2921 were excluded after the title and abstract screening. Of the 196 articles left for full-text screening, 178 did not meet our inclusion criteria (disagreement in 8 of 196 screened articles; interrater reliability, 95.9%), deeming 18 of the retrieved articles eligible for inclusion.47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64 An additional 7 articles were included through citation and reference search,65,66,67,68,69,70,71 and 1 article was included after updating the database search72 (Figure 1). Authors of 21 articles with insufficient data to estimate an OR were contacted, of which 1 author provided sufficient information on participant distribution.58 In total, we included 26 articles.47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72

Figure 1. PRISMA Flowchart of Study Selection.

Figure 1.

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Study Characteristics

Study characteristics and risk of bias scores of the 26 included articles are presented in the Table. Geographically, the studies represented the following continents: Asia (n = 8), Australia (n = 2), Europe (n = 9), North America (n = 5), and South America (n = 2). Sample sizes varied between 37 and 85 080 women, totaling 100 877 postpartum women from 24 cohort studies and 2 case-control studies. Family history of psychiatric disorders was primarily assessed using self-reported questionnaires (n = 23), and PPD was assessed using validated instruments (n = 13), clinical interviews (n = 12), and nationwide registers (n = 1). PPD was assessed from 1 to 52 weeks’ post partum, on average at 10 weeks’ post partum. Risk of bias scores ranged from 2 to 9 (eMethods 3 in the Supplement).

Table. Characteristics of Included Studies.

Administrative information Sample Methods Quality, risk of bias assessment score
Source Location Sample size population, No. Sample characteristics Study design Family psychiatry assessment method PPD assessment method PPD assessment post partum
Abdollahi et al,47 2014 Iran, Asia 1546 Community-based Cohort Questionnaire (self-report) Validated instrument (EPDS) Cumulated 0-12 wk 5
Boyce and Hickey,65 2005 Australia 425 Community-based Cohort Questionnaire (self-report) Clinical interview (SCID-IV) Cumulative 0-24 wk 8
Çankaya,66 2020 Turkey, Asia 245 Community-based Cohort Questionnaire (self-report) Validated instrument (EPDS) Between 6-8 wk 4
Chee et al,48 2005 Singapore, Asia 278 Community-based Cohort Questionnaire (self-report) Clinical interview (SCID-IV) 6 wk 6
Corwin et al,49 2015 US, North America 152 Selected group Cohort Questionnaire (self-report) Validated instrument (EPDS) Cumulated 0-6 mo 2
Dasgupta et al,72 2021 India, Asia 72 Selected group Cohort Questionnaire (self-report) Validated instrument (EPDS) 1 wk 4
Dennis and Ross,50 2006 Canada, North America 569 (1 wk); 487 (8 wk) Community-based Cohort Questionnaire (self-report) Validated instrument (EPDS) 1 wk and 8 wk 3
English et al,51 2018 UK, Europe 480 NA Cohort Questionnaire (self-report) Validated instrument (EPDS) Between 6-10 wk 2
Gausia et al,52 2009 Bangladesh, Asia 346 Community-based Cohort Questionnaire (self-report) Validated instrument (EPDS) Between 6-8 wk 5
Guintivano et al,53 2018 US, North America 1517 Selected group Case-control Questionnaire (self-report) Clinical interview (MINI+) 6 wk 4
Johnstone et al,54 2001 Australia 490 Community-based Cohort Questionnaire (self-report) Validated instrument (EPDS) 8 wk 3
Kimmel et al,55 2015 US, North America 37 Selected group Cohort Questionnaire (self-report) Clinical interview (SCID-IV) 1 mo 3
Kirpinar et al,56 2010 Turkey, Asia 479 Community-based Cohort Questionnaire (self-report) Validated instrument (EPDS) 6 wk 4
Lin et al,57 2019 Taiwan, Asia 234 Selected group Cohort Questionnaire (self-report) Clinical interview (MINI+) 4 wk 5
Nielsen Forman et al,67 2000 Denmark, Europea 3546 Community-based Cohort Questionnaire (self-report) Validated instrument (EPDS) 4 mo 6
Meltzer-Brody et al,58 2018 Denmark, Europeb 85 080 Population-based Cohort Registers Register 0-6 mo 9
O’Hara,68 1986 US, North America 99 Selected group Cohort Questionnaire (self-report) Clinical interview (SADS) 9 wk 4
Pham et al,59 2018 Argentina, South America 539 Selected group Cohort Questionnaire (self-report) Validated instrument (EPDS) 4 wk 3
Pop et al,69 1995 The Netherlands, Europe 293 Community-based Cohort Questionnaire (self-report) Clinical interview (RDC) 4 wk 6
Radoš et al,71 2013 Croatia, Europe 272 Community-based Cohort Questionnaire (self-report) Clinical interview (SCID-IV) 6 wk 5
Rambelli et al,60 2010 Italy, Europe 600 Community-based Cohort Validated instrument (FHS) Clinical interview (SCID-IV) 6 mo 7
Saldanha et al,70 2014 India, Asia 186 Selected group Cohort Questionnaire (self-report) Validated instrument (EPDS) Cumulated 0-6 wk 5
Silva et al,61 2012 Brazil, South America 810 Selected group Cohort Questionnaire (self-report) Validated instrument (EPDS) Between 30-60 d 3
Stickel et al,62 2021 Germany, Europe 196 Community-based Cohort Questionnaire (self-report) Clinical interview (HDRS-17) 12 wk 5
Tebeka et al,63 2021 France, Europe 2109 (2 mo); 2094 (12 mo) Selected group Case-control Validated instrument (FISC) Clinical interview (DIGS) 2 mo; 12 mo 7
Verkerk et al,64 2005 The Netherlands, Europe 277 (3, 6, and 12 mo) Community-based Cohort Questionnaire (self-report) Clinical interview (RDC) 3 mo; 6 mo; 12 mo 6
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Abbreviations: DIGS, Diagnostic Interview for Genetic Studies; EPDS, Edinburgh Postnatal Depression Scale; FHS, Family History Screen; FISC, Family Informant Schedule and Criteria; HDRS-17, Hamilton Depression Rating Scale; MINI+, Mini-International Neuropsychiatric Interview; PPD, postpartum depression; RDC, Research Diagnostic Criteria; SADS, Schedule for Affective Disorders and Schizophrenia; SCID-IV, Structured Clinical Interview for DSM-4.

a

Overlapping study sample with another included article; therefore, this was not included in meta-analysis.

b

Numbers were obtained from the authors.

Primary Analysis: Family History of Psychiatric Disorders and PPD

Of the 26 included articles, 25 were included in the analyses, as 2 studies had overlapping study samples and only one of them was included in the analyses.58,67 The primary analysis showed increased odds of PPD when having family history of psychiatric disorders (OR, 2.08; 95% CI, 1.67-2.59; I2 = 57.14%) (Figure 2), corresponding to a relative risk of 1.79 (95% CI, 1.52-2.09), assuming a 15% prevalence of PPD in the general population.1,2

Figure 2. Primary Analysis.

Figure 2.

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Pooled association between family history of psychiatric disorders and postpartum depression.

Secondary Analyses: Assessment Time Post Partum and Definition of Family History of Psychiatric Disorders and PPD

Although the OR point estimate for PPD was higher within the first 12 weeks post partum (OR, 2.18; 95% CI, 1.69-2.81), it did not differ statistically from PPD assessed between 13 to 26 weeks post partum (OR, 1.63; 95% CI, 1.18-2.25) and 27 to 52 weeks post partum (OR, 1.35; 95% CI, 0.74-2.49) (Figure 3). The ORs for the association between PPD and family history of psychiatric disorders seemed higher when family history of psychiatric disorders was self-reported compared with when ascertained through validated instruments or registries. However, as only few studies used validated instruments (n = 2) and registries (n = 1), the accuracy of these results is limited (eFigure 1 in the Supplement). Furthermore, stratification on how PPD was assessed showed no difference in ORs for developing PPD between assessment with clinical interviews or validated instruments (eFigure 2 in the Supplement).

Figure 3. Stratified Analysis by Postpartum Depression Assessment Time.

Figure 3.

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Subgroup, Sensitivity, and Meta-regression Analysis

Overall, the results of the subgroup, sensitivity, and meta-regression analyses were in line with the main findings. Studies with a selected sample (n = 10) seemed to have higher ORs for developing PPD than studies using community-based populations (n = 13). However, the 95% CIs of these subgroups overlapped, thereby showing no significant difference between the groups (eFigure 3 in the Supplement). Subgroup analysis by country showed that studies performed in Europe had lower ORs for developing PPD compared with those performed in Asia (eFigure 4 in the Supplement).

Subgroup analyses of study design (eFigure 5 in the Supplement) and cumulative vs point prevalence estimates (eFigure 6 in the Supplement) and sensitivity analyses of unadjusted vs adjusted estimates (eFigures 7 and 8 in the Supplement) and omitting studies with high risk of bias score (eFigure 9 in the Supplement) did not alter the findings. Similarly, the meta-regression analyses testing participant characteristics of age, primiparity, personal depression or psychiatric history, and risk of bias score did not influence the results (eFigures 10 to 14 in the Supplement).

Publication Bias

Visual inspection of the funnel plot suggested the potential for small study bias (Figure 4); however, the Peters test did not confirm this. Furthermore, after removing small studies with extreme results,57,68,70,72 the pooled OR was lower but not statistically significantly different from the primary analysis (1.78 [95% CI, 1.47-2.14] vs 2.08 [95% CI, 1.67-2.59]) (eFigures 15 and 16 in the Supplement), suggesting no impact of publication bias.

Figure 4. Funnel Plot.

Figure 4.

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Quality of the Evidence

The overall certainty of the evidence, according to GRADE, was deemed moderate for the association between family history of psychiatric disorders and PPD. We downgraded the overall certainty of evidence because of inconsistency of the estimates (eTable in the Supplement).

Discussion

This systematic review and meta-analysis identified an almost doubled risk of developing PPD in mothers with family history of psychiatric disorders compared with mothers without. This is in contrast to several systematic and umbrella reviews, compiling all risk factors.7,8,9,10,11,12,13,14,15,16,17,18,19,20,21 However, our findings are supported through studies of heritability of psychiatric disorders within, but especially outside, the postpartum period, indicating family history of psychiatric disorders is a strong risk factor for developing psychiatric episodes.28,29,30,31,32,33,34,35 This discrepancy in support of our findings could be because of methodological differences, as in our systematic review, we included studies regardless of their primary aim conditional on reporting a risk estimate for the association between family history of psychiatric disorders and PPD. Additionally, we also included studies if they reported sufficient information for us to calculate this estimate, which led to inclusion of 12 additional studies based on this criterion.49,55,56,57,58,61,62,66,68,70,71,72 In contrast, in some systematic reviews, it is not clear whether such an inclusion criterion was applied,7,8,9,10,14,15,16,17,18 and no meta-analysis was performed.9,15,16,17,18 Few reviews focused on the general population as we did,7,8,9,14 and among them, some had prespecified risk factors or themes of interest.8,9 Others were based on more selected populations11,15,16,17,18 or country-specific populations.10,12,13 Some excluded high-risk populations,10,14,15 and some were primarily investigating PPD prevalence and only secondarily investigating risk factors for PPD, which was reflected in their literature search.12,16,17,18

It is outside the scope of this review to investigate why family history of psychiatric disorders is a risk factor for PPD, but it is most likely due to both genetic and environmental factors during upbringing and later in life, as suggested for psychiatric disorders outside the postpartum period.73 Growing up in an environment with parents struggling with mental health problems potentially influences the social support received from these parents when going into motherhood. This particular explanation is supported by umbrella reviews concluding that lack of social support is a significant PPD risk factor.19,20

Implications of Findings

Family history of psychiatric disorders was assessed with self-report in most studies (n = 23), which indicates potential benefits of using a single self-reported question on family history of psychiatric disorders in routine perinatal care when trying to identify high-risk women. Adding to this, personal psychiatric history is another strong PPD risk factor.19,20 Jointly, this suggests the potential for a quick and low-cost assessment of PPD risk in clinical practice using only 2 self-reported questions: history of personal and family psychiatric disorders. As the assessment is possible even prior to conception, this would leave time for planning preventive efforts, eg, psychosocial and psychological interventions targeting these at-risk women.74

It is beyond the reach of this review to suggest actionable clinical implications, but next steps could focus on how and when to screen for family history of psychiatric disorders while also considering how these screening questions will fit with existing screening practices. Our findings are relevant to consider moving forward and could inform selective prevention efforts targeting women with a family history of psychiatric disorders. These steps will assist identification of women at risk of PPD but will need to do this in a way that would allow appropriate allocation of scarce resources.

Strengths and Limitations

Our systematic review has several strengths, including alignment with the originally published protocol,40 stringent search string, and screening, extraction, and assessment of included studies done independently by 2 reviewers, all of which reduce reporting bias and increase validity.37 However, there are also limitations. Family history of psychiatric disorders was measured through self-report in most of the included studies (n = 23). Phrasing of the self-reported question was very diverse and inconsistent: only 7 studies asked specifically about first-degree family members50,53,54,63,64,68,69 and 10 studies asked about specific diagnosis,47,49,50,51,53,54,55,64,68,69 covering diagnosis from mild affective disorders to more intrusive disorders, such as schizophrenia. This prevents us from investigating how the type of specific diagnosis or family members affect the risk of developing PPD, and we are unable to make conclusion about specificity of the question. Furthermore, self-report of psychiatric disorders often leads to underreporting in terms of social desirability bias because of, eg, risk of stigma.75 The potential underreporting of family history of psychiatric disorders would have led to misclassification; therefore, the true association potentially could be even stronger.

Our inclusion criteria related to language were articles in English, Danish, Norwegian, Swedish, and Italian, which led to exclusion of 6 articles in other languages in the full-text screening. This constitutes only a small part of the excluded articles (n = 178), which is unlikely to have led to considerable bias. We included only peer-reviewed studies. However, the funnel plot did not reveal considerable small-study biases, and a subgroup analysis removing 4 studies with small samples and extreme results did not alter the overall finding.

Conclusions

Based on 26 studies from 18 countries representing 5 continents, this systematic review and meta-analysis highlights mothers with a family history of any psychiatric disorder have an almost doubled risk of developing PPD compared with mothers without. Information on family history of psychiatric disorders is easy to identify through simple self-reported question(s), potentially as part of routine perinatal care, and early identification makes timely and targeted intervention possible to prevent PPD or mitigate the consequences thereof.

Supplement.

eMethods 1. MOOSE Checklist

eMethods 2. Specifications to the Review Protocol

eMethods 3. Risk of Bias Scores, Newcastle-Ottawa Scale

eFigure 1. Secondary Analysis, Stratified Analysis on Exposure Definition

eFigure 2. Secondary Analysis, Stratified Analysis on Outcome Definition

eFigure 3. Subgroup Analysis, Stratified on Sample Type

eFigure 4. Subgroup Analysis, Stratified on Geography

eFigure 5. Subgroup Analysis, Stratified on Study Design

eFigure 6. Subgroup Analysis, Stratified on Cumulative and Point Prevalence Estimates

eFigure 7. Sensitivity Analysis, Stratified on Unadjusted and Adjusted Estimates

eFigure 8. Sensitivity Analysis Including Studies Reporting Both Unadjusted and Adjusted Estimates

eFigure 9. Sensitivity Analysis Excluding High Risk of Bias Studies (Excluding Studies With Score 1-4 in Risk of Bias Assessment)

eFigure 10. Meta-regression, Bubble Plot, Mean Age

eFigure 11. Meta-regression, Bubble Plot, Primiparity

eFigure 12. Meta-regression, Bubble Plot, Personal Depression History

eFigure 13. Meta-regression, Bubble Plot, Personal Psychiatric History

eFigure 14. Meta-regression, Bubble Plot, Risk Of Bias Score

eFigure 15. Funnel Plot, Sensitivity Analysis Excluding Small Studies With Extreme Results

eFigure 16. Sensitivity Analysis of the Primary Analysis, Excluding Small Studies With Extreme Results

eTable. Summary of Findings Table According to GRADE

eReferences.

Click here for additional data file. (1.5MB, pdf)

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplement.

eMethods 1. MOOSE Checklist

eMethods 2. Specifications to the Review Protocol

eMethods 3. Risk of Bias Scores, Newcastle-Ottawa Scale

eFigure 1. Secondary Analysis, Stratified Analysis on Exposure Definition

eFigure 2. Secondary Analysis, Stratified Analysis on Outcome Definition

eFigure 3. Subgroup Analysis, Stratified on Sample Type

eFigure 4. Subgroup Analysis, Stratified on Geography

eFigure 5. Subgroup Analysis, Stratified on Study Design

eFigure 6. Subgroup Analysis, Stratified on Cumulative and Point Prevalence Estimates

eFigure 7. Sensitivity Analysis, Stratified on Unadjusted and Adjusted Estimates

eFigure 8. Sensitivity Analysis Including Studies Reporting Both Unadjusted and Adjusted Estimates

eFigure 9. Sensitivity Analysis Excluding High Risk of Bias Studies (Excluding Studies With Score 1-4 in Risk of Bias Assessment)

eFigure 10. Meta-regression, Bubble Plot, Mean Age

eFigure 11. Meta-regression, Bubble Plot, Primiparity

eFigure 12. Meta-regression, Bubble Plot, Personal Depression History

eFigure 13. Meta-regression, Bubble Plot, Personal Psychiatric History

eFigure 14. Meta-regression, Bubble Plot, Risk Of Bias Score

eFigure 15. Funnel Plot, Sensitivity Analysis Excluding Small Studies With Extreme Results

eFigure 16. Sensitivity Analysis of the Primary Analysis, Excluding Small Studies With Extreme Results

eTable. Summary of Findings Table According to GRADE

eReferences.

Click here for additional data file. (1.5MB, pdf)

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