Study Pinpoints Moms Who Are at Highest Risk for Postpartum Depression

Depressed mom with baby

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Key Takeaways

  • Twin births and births to young moms are risk factors for postpartum depression.
  • Postpartum depression symptoms are similar to those of other depressive disorders.
  • Being aware of your family history, knowing what symptoms to look for, and having a strong support system can lessen your risk of the disorder.

Mothers over age 40 who have given birth to twins have the highest risk of postpartum depression, according to a new study published in the Journal of Affective Disorders. The risk of postpartum depression is also higher for first-time mothers and birthing parents under the age of 25. The study findings came from answers to survey questions about postpartum feelings and emotions. Over 1 million moms worldwide participated, making this study one of the largest of its kind.

“I think the significance of this study is really that it’s large, it’s cross-cultural, it’s cross-national, and it really makes it clear that, for instance, twin pregnancies [lead to] a higher risk than single pregnancies. Younger age is [also] clearly a risk factor,” explains Jennifer L. Payne, MD, the lead author of the study and director of the Reproductive Psychiatry Research Program at the University of Virginia School of Medicine.

Postpartum depression develops after giving birth. “Postpartum depression is actually the most common complication of giving birth and most people don’t realize that,” Dr. Payne adds. The mental health condition causes feelings of anxiety, sadness, hopelessness, and can interfere with your ability to do daily tasks. In the United States, one in eight pregnant people deal with symptoms of postpartum depression.

One of the first steps in dealing with the condition is recognizing the symptoms. Signs of postpartum depression include extreme sadness and frequent crying, having thoughts of hurting yourself or your baby, having little energy or trouble focusing, and problems with sleeping. Experts say if symptoms persist for more than two weeks, you should reach out to your healthcare provider.

What the Study Found

Researchers from the University of Virginia School of Medicine, John Hopkins University, and Flo Health used the Flo app to distribute the survey to people who had given birth. Over 1 million women from 138 countries responded to the “After Childbirth Survey” between January 2018 to April 2020. Women answered questions about their mood and emotional state after delivery, with responses ranging from being in “high spirits” to “experiencing anxiety, irritability, dissatisfaction” or "feeling hopeless and sad."

Approximately 10% of women ages 18 to 24 noted symptoms of PPD and more first-time moms experienced symptoms than those who had previously given birth. The highest risk of postpartum depression occurred in those with twin pregnancies; 15% experienced postpartum depression symptoms.

“Twin pregnancies are more likely to be complicated, and complicated pregnancies have higher rates of postpartum depression,” Dr. Payne states. “I think there’s also psychosocial reasons why women over the age of 40 with twin pregnancies might have a higher rate in that ... when you’re over 40, suddenly having twins could be a shock to your system,” she adds.

Along with younger age and twin births, other risk factors of PPD include a history of major depressive or bipolar disorder, a family history of postpartum depression, relationship or financial problems, difficulty breastfeeding, health problems with the baby, and depression during pregnancy.

“It’s actually quite important to identify and treat postpartum depression, not only to make mom feel better but to improve outcomes for her children,” Dr. Payne says. “If mom is depressed postpartum … the exposed children have lower IQs, lower language development, and they’re more likely to develop ADHD, and have behavioral problems. There appears to also be an increased risk for the later development of psychiatric disorders.”

Lowering Your Risk and Getting Help

There are things that you can do to help lessen your risk of developing postpartum depression.

First, educate yourself. Find out if anyone in your family struggled with depressive episodes. Be in tune with yourself and aware of your mood, behaviors, and emotions. If something seems off or unsettling, don’t ignore it. Seek medical help if needed.

Practical steps you can take include surrounding yourself with a strong social support system, getting out in the fresh air and exercising, incorporating times of calm and meditation, taking medication prescribed by your doctor, and talking with a therapist.

Ultimately, the more people discuss the risks, symptoms, and ways to get help for postpartum depression, the better off delivering mothers and their children will be.

“It’s kind of like this hidden secret, and sadly most women don’t get identified or treated and we need to be doing better than that, and we can be doing better than that,” Dr. Payne says.

What This Means For You

Being a parent can be a tough and emotional experience. But when difficult or negative emotions persist after giving birth, moms should seek help. Dealing with postpartum depression is nothing to be ashamed of. Talk about your feelings, seek out support, and get the help that you need.

4 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Bradshaw H, Riddle JN, Salimgaraev R, et al. Risk factors associated with postpartum depressive symptoms: A multinational study. J Affective Disord. 2022;301:345-351. doi:10.1016/j.jad.2021.12.121

  2. American College of Obstetricians and Gynecologists. Postpartum depression.

  3. Centers for Disease Control and Prevention. Depression among women.

  4. US Department of Health & Human Services. Postpartum depression.

By LaKeisha Fleming
LaKeisha Fleming is a prolific writer with over 20 years of experience writing for a variety of formats, from film and television scripts, to magazines articles and digital content. She has written for CNN, Tyler Perry Studios, Motherly, Atlanta Parent Magazine, Fayette Woman Magazine, and numerous others. She is passionate about parenting and family, as well as destigmatizing mental health issues. Her book, There Is No Heartbeat: From Miscarriage to Depression to Hope, is authentic, transparent, and providing hope to many.Visit her website at