Postpartum Depression Linked to Nearly Triple Infant Death Risk

Families searching for mental health treatment facilities after a birth are usually told that postpartum depression is common, treatable, and a maternal concern. A new study suggests a positive screen also marks an infant at elevated risk. But researchers and outside experts are careful about which direction the arrow points.

Rebecca Woofter’s team analyzed New Jersey birth records from 2016 through 2020 for 414,890 singleton infants. Infants whose mothers screened positive for depressive symptoms after delivery died at 7.2 per 1,000 births. Among infants whose mothers didn’t screen positive, the rate was 2.0 per 1,000.

The Adjusted Numbers

The raw relative risk was 3.36. Adjusting for maternal and infant demographic and socioeconomic factors brought it to 2.89 (95% CI, 2.36 to 3.54). Adding smoking, substance use, preterm birth and low birth weight brought it down further to 1.97.

Prior research relied on depression diagnoses in medical charts. But this approach misses a great deal. Fewer than half of mothers with depression receive a diagnosis. Race and ethnicity play key roles in who gets diagnosed.

New Jersey has a robust system in place to help folks of all backgrounds with depression. The state mandates immediate postpartum period screenings before hospital discharge. Hospitals use the 10-item Edinburgh Postnatal Depression Scale and a score of 10 or higher was the threshold.

But the Edinburgh scale identifies symptoms rather than a clinical diagnosis. It might miss women who develop postnatal depression weeks or months later. 

The Caveat That Changes the Reading

Depressive symptoms were measured after delivery. By that point, a mother might be depressed because she knows her baby had a congenital abnormality and is at risk of early death. 

But the study doesn’t establish that maternal depression causes infant deaths. The deaths were underpinned by “genuine biological causes” largely outside any mother’s control.

The cause-specific figures illustrate the problem. Adjusted relative risks were 5.12 for perinatal conditions, 4.07 for prematurity-related conditions, 3.56 for congenital malformations and chromosomal abnormalities and 2.08 for sudden infant death syndrome. A mother would have known about these conditions before undergoing a screening. 

The researchers expected larger numbers among Black mothers and poorer mothers of inequities. But the association held consistently across race and ethnicity. The same went for educational level, insurance status and preterm birth status. Of the 414,890 infants, 906 died.

Mental Health and Addiction Connection

Co-occurring disorders describe a mental health condition and a substance use disorder present at the same time. Depression frequently overlaps with substance use. The study accounted for maternal tobacco and drug use like benzo during pregnancy as risk factors.

Treating one without the other leaves the person where they started. Integrated care works around a schedule built around an infant. Programs offering childcare, telehealth sessions or family-inclusive scheduling remove barriers.

Call our helpline at 800-908-4823 (Sponsored) to explore local options with an expert. You can also compare programs by browsing our directory listings for dual diagnosis and behavioral health facilities.

Author

Nikki Wisher, BA

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Nikki Wisher is an Atlanta-based content writer who specializes in health and wellness. After earning her BA in English, she has been writing in the health and wellness space for over a decade, with credits ranging from addiction recovery to fitness to aesthetics and skin care. This includes her inclusive running blog forallrunners.com.

Editor

Peter Lee, PhD

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Peter W.Y. Lee is a writer and historian of American history during the Cold War. His primary focus is the relationship between youth and popular culture and its impact on U.S. society during the twentieth century. He has published widely on how the public has used popular culture as a mechanism to address political and social shifts throughout time