Summary: A comprehensive Swedish cohort study of nearly 1.8 million pregnancies found that maternal mental health problems have increased in recent years, with a notable rise in risk after childbirth. While rates of new diagnoses for depression and psychosis fall during pregnancy, the risk of postpartum depression rises by about 20% during weeks 5–15 after delivery, and the risk of psychosis can be as much as seven times higher during the first 20 weeks postpartum.
The introduction of national screening guidelines in 2020 appears to have shifted detection earlier, allowing some women to be identified and treated sooner, even though the overall number of diagnoses did not increase. The authors emphasize the importance of ongoing monitoring and timely support to protect maternal mental health and reduce the risk of severe outcomes, including suicide.
Key Facts
- Depression Spike: Incidence of depression is about 20% higher in postpartum weeks 5–15 compared with the year before pregnancy.
- Psychosis Risk: Incidence of psychosis can be up to seven times greater in the first 20 weeks following childbirth.
- Screening Impact: Screening guidelines introduced in 2020 have led to earlier detection of postpartum depression without increasing overall diagnostic rates.
Source: Karolinska Institute
Mental ill health around pregnancy can have long-term consequences for women’s well-being. Pregnancy and the postpartum period involve large biological and psychosocial changes that increase vulnerability to depression, anxiety, and other psychiatric disorders.
Although previous studies have investigated perinatal mental health, there has been limited population-level evidence describing how different psychiatric diagnoses change before, during, and after pregnancy. To address this gap, researchers used national registers covering all births in Sweden from 2003 to 2019, totaling 1,799,010 pregnancies from 1,052,977 women.
Published in the journal Molecular Psychiatry, the study reports that the overall incidence of maternal psychiatric disorders rose between 2003 and 2019, particularly for disorders identified in the year before conception. Across the cohort, new psychiatric diagnoses declined during pregnancy but returned to pre-pregnancy levels during the postpartum year. However, depression and psychosis showed distinct patterns, with clear increases shortly after delivery.
“We observed approximately a 20 percent higher risk of depression in weeks 5 to 15 after childbirth compared with the year before pregnancy,” says Emma Bränn, the study’s first author and a researcher at the Institute of Environmental Medicine at Karolinska Institutet. “For psychosis, the risk was up to seven times higher during the first 20 weeks postpartum.”
When Sweden introduced national screening guidelines for depression during pregnancy in 2020, it created an opportunity for earlier detection. Comparing births before and after the guideline implementation, the researchers found that the peak in depression diagnoses appeared earlier after delivery in the group giving birth under the new screening protocol. The total number of diagnosed cases did not increase, suggesting screening mainly accelerated detection rather than identifying more cases overall.
“Screening may help women get support sooner so they do not need to endure symptoms for as long before receiving care,” Emma Bränn adds.
The analysis also found that rates of other psychiatric conditions—such as anxiety, stress-related disorders, and substance use disorders—were lower during pregnancy and the postpartum period than in the year before pregnancy. The researchers suggest this pattern could reflect biological changes in pregnancy, lifestyle adjustments, and more frequent contact with healthcare services during this period.
A separate study from the same research group, published in Nature Human Behaviour, examined parental suicide attempts around the time of childbirth. Using nationwide data covering more than 2.19 million pregnancies, the researchers compared week-by-week incidence in the year before conception, during pregnancy, and in the year after birth.
They identified 7,469 suicide attempts among mothers and 8,338 among fathers. Compared with the equivalent preconception weeks, mothers showed a lower risk of suicide attempt during pregnancy and in the postpartum year, with the lowest relative risk in the first week after birth. Fathers’ risk remained relatively stable before birth, dipped in the first ten weeks postpartum, then rose later in the postpartum year.
“Both mothers and fathers are less likely to attempt suicide immediately after having a child, particularly mothers,” says Yihui Yang, a PhD student at the Institute of Environmental Medicine and first author on the suicide study. “Although attempts are rare during and after pregnancy, they can have devastating and often preventable consequences. Regular screening and follow-up by healthcare providers are crucial to identify parents who need support and to prevent suicide.”
Both studies received funding from Karolinska Institutet, the Swedish Research Council, and other research funders; the Molecular Psychiatry study also received partial support from the Uppsala Medical Faculty Foundation. The authors report no conflicts of interest.
About this mental health research news
Author: Press Office
Source: Karolinska Institute
Contact: Press Office – Karolinska Institute
Image: The image is credited to Neuroscience News
Original Research: Open access.
“Maternal psychiatric disorders before, during, and after pregnancy: a national cohort study in Sweden” by Emma Bränn et al. Molecular Psychiatry
Open access.
“Sex difference in parental risk of suicide attempt during and after pregnancy in Sweden” by Emma Bränn et al. Nature Human Behaviour
Abstract
Maternal psychiatric disorders before, during, and after pregnancy: a national cohort study in Sweden
Maternal mental health is a major public health concern, yet population-based evidence describing how incident psychiatric disorders vary before, during, and after pregnancy is limited. This study aimed to document calendar-time trends and compare the risks of maternal psychiatric disorders across the preconception year, pregnancy, and the postpartum year.
Using Sweden’s national and regional registers, the researchers followed all women giving birth between 2003 and 2019 (1,799,010 pregnancies from 1,052,977 women). They identified incident psychiatric diagnoses recorded in each of the three periods, calculated age- and calendar-year standardized incidence rates (SIRs) annually and by week, and estimated incidence rate ratios (IRRs) using the corresponding preconception weeks as the reference.
Overall, the SIR for maternal psychiatric disorders increased from 2003 to 2019, most noticeably for disorders diagnosed in the preconception year. Weekly SIRs in the preconception year were stable at about 25 per 1,000 person-years, declined through pregnancy to a low near 4 per 1,000 person-years, and returned to preconception levels in the postpartum year. This pattern held for most disorder subtypes, except that depression and psychosis exhibited postpartum increases at weeks 5–15 and 0–20, respectively.
In summary, the study documents a rising incidence of maternal psychiatric disorders over time and highlights an elevated risk of postpartum depression and psychosis shortly after delivery, while other psychiatric disorders tended to be less frequent during and after pregnancy compared with before pregnancy.
Abstract
Sex difference in parental risk of suicide attempt during and after pregnancy in Sweden
It remains unclear whether risks of suicide attempt differ between mothers and fathers during and after pregnancy. This nationwide register-based study in Sweden (2,196,276 pregnancies) defined the year before conception, pregnancy, and the year after birth and estimated week-specific incidence rate ratios (IRRs).
The study identified 7,469 suicide attempts among mothers (1.39 per 1,000 person-years) and 8,338 among fathers (1.62 per 1,000 person-years). Compared with corresponding preconception weeks, mothers had a lower risk of suicide attempt during pregnancy and the postpartum year, with the lowest IRR at the first week postpartum. Fathers’ risk was largely stable before childbirth, showed a reduced risk during the first 10 postpartum weeks, and increased in the later postpartum period.
Overall, mothers had a lower risk of suicide attempt than fathers during and after pregnancy, an observation that reverses the typical sex difference seen in the general population and suggests pregnancy and childbirth may have distinct associations with suicide risk for parents.