Summary: A major Swedish register study shows that women who experience perinatal depression—during pregnancy or within a year after childbirth—face a substantially increased risk of death from both natural and unnatural causes. Analyzing data from more than 86,500 affected women and 865,500 matched controls, the research found elevated mortality risk that is highest in the first month after diagnosis but remains significant for up to 18 years.
The findings underscore the importance of systematic screening, timely intervention, and continuous psychiatric care for women with perinatal depression to reduce longer-term health risks.
Key Facts:
- Women diagnosed with perinatal depression had roughly double the overall mortality risk compared with women without the diagnosis; the risk is most acute within the month after diagnosis and persists for many years.
- The study used national data from the Swedish Medical Birth Register, comparing 86,551 women with clinically ascertained perinatal depression to 865,510 age- and calendar-year matched controls, making it one of the largest studies on this topic.
- Perinatal depression affects an estimated 10–20% of pregnant women and is commonly treated with psychological therapies such as cognitive behavioral therapy (CBT), with medication when indicated.
Source: Karolinska Institute
Overview
A nationwide register-based study in Sweden, published in The BMJ, found that women diagnosed with perinatal depression face an increased risk of death from both unnatural and natural causes. The relative risk was highest immediately after diagnosis, especially within the first 30 days, and remained elevated for up to 18 years of follow-up.
Perinatal depression—depression that begins during pregnancy (antepartum) or within the first year after childbirth (postpartum)—was associated with an overall adjusted hazard ratio of about 2.1 for all-cause mortality compared with women who did not develop the disorder. The risk of suicide was particularly pronounced, with suicide risk approximately six times higher among women with perinatal depression than among unaffected women, although suicide remained a rare outcome in absolute terms.
The study found that postpartum depression was linked to a higher mortality risk than antepartum depression, consistent with earlier, smaller studies. Importantly, elevated mortality risk was observed both in women with and without prior psychiatric history, indicating that the increased risk is not solely explained by existing mental-health conditions before pregnancy.
Researchers observed that women diagnosed with perinatal depression were more likely to have been born in the Nordic region and to have shorter education and lower incomes than those without the diagnosis. The authors suggest that differences in how and when women seek help, and possible variations in screening or follow-up care, could contribute to the observed disparities. They argue for better use of existing screening tools and evidence-based care rather than relying solely on new measures.
Clinical and Public Health Implications
The study highlights the need for systematic screening for perinatal depression both during pregnancy and in the postpartum period, timely access to evidence-based treatments such as CBT and medication when appropriate, and ongoing follow-up. Early identification and sustained support could help reduce the short-term and long-term risks associated with perinatal depression, including the elevated risk of suicide in the period following diagnosis.
Funding: The research was supported by the Swedish Research Council for Health, Working Life and Welfare (Forte), the Swedish Research Council, Karolinska Institutet’s Strategic Research Area in Epidemiology and Biostatistics (SFOepi), and the Icelandic Research Fund.
Facts:
- Perinatal depression is relatively common, affecting approximately 10–20% of pregnant women.
- Depression occurring around pregnancy can have serious, long-term consequences for maternal health.
- Prior research had linked postpartum depression with increased suicide risk; this study expands knowledge about longer-term mortality risks linked to both antepartum and postpartum depression.
- In Sweden, routine screening for postpartum depressive symptoms is performed with the Edinburgh Postnatal Depression Scale (EPDS) at about six to eight weeks after childbirth.
- Recommended treatments for perinatal depression include cognitive behavioral therapy and other psychological therapies, often combined with medication when clinically needed.
About this research
Author: Qing Shen
Source: Karolinska Institute
Contact: Qing Shen – Karolinska Institute
Image credit: Neuroscience News
Original Research: Open access. Title: “Perinatal depression and risk of mortality: nationwide, register based study in Sweden” by Qing Shen et al., published in The BMJ.
Abstract
Perinatal depression and risk of mortality: nationwide, register based study in Sweden
Objective
To determine whether women diagnosed with perinatal depression have an increased risk of death compared with women who did not develop the disorder, and compared with their full sisters.
Design
Nationwide, register-based cohort study.
Setting
Swedish national registers, from 1 January 2001 to 31 December 2018.
Participants
The analysis included 86,551 women with a first recorded diagnosis of perinatal depression—ascertained through specialised care and antidepressant use—and 865,510 matched women without perinatal depression. To control for familial confounding, comparisons were also made within 270,586 full sisters (24,473 sisters with perinatal depression and 246,113 sisters without), all of whom had at least one singleton birth during the study period.
Main outcome measures
Primary outcome was death from any cause. Secondary outcomes included cause-specific death (unnatural versus natural causes). Multivariable Cox regression models estimated hazard ratios for mortality, adjusting for confounders. Temporal patterns and differences between antepartum and postpartum onset were also examined.
Results
Over up to 18 years of follow-up, 522 deaths (0.82 per 1,000 person-years) occurred among women with perinatal depression, who were diagnosed at a median age of 31. Compared with women without perinatal depression, affected women had an adjusted hazard ratio for all-cause mortality of 2.11 (95% CI 1.86 to 2.40). This association was present regardless of prior psychiatric history.
Risk was higher for postpartum than antepartum depression (hazard ratio 2.71, 95% CI 2.26 to 3.26, versus 1.62, 95% CI 1.34 to 1.94). A sibling comparison yielded a similar association (hazard ratio 2.12, 95% CI 1.16 to 3.88). The elevated risk was most pronounced within the first year after diagnosis but persisted up to 18 years of follow-up.
Both unnatural and natural causes contributed to the increased mortality: hazard ratios were 4.28 (95% CI 3.44 to 5.32) for unnatural causes and 1.38 (95% CI 1.16 to 1.64) for natural causes. Suicide showed the strongest specific association (hazard ratio 6.34, 95% CI 4.62 to 8.71), though it remained an uncommon event (0.23 per 1,000 person-years).
Conclusions
Clinically diagnosed perinatal depression was associated with an increased risk of death, particularly in the first year after diagnosis and due to suicide, even after accounting for familial factors. Affected women, their families, and health professionals should be aware of these serious risks, and efforts should focus on early detection, continuous care, and appropriate evidence-based treatment.