The association of psycho-economic factors with postpartum depression without significant medical complications for the mother and infant: a systematic review and meta-analysis.

backgroundPostpartum depression (PPD) is a significant mood disorder affecting mothers during the postpartum period. Multiple factors, including biological, psychological, social, and economic aspects, influence PPD. This study aimed to investigate the association between psycho-economic factors in the field of midwifery with postpartum depression without significant medical complications for the mother and infant through a systematic review and meta-analysis.

methodsWe conducted a systematic review and meta-analysis of English- and Persian-language articles published between 2000 and 2023, using databases including PubMed/MEDLINE, Web of Science, PsycINFO, Cochrane Library, Scopus, EMBASE, Google Scholar, SID, and Magiran. Keywords used were “Economic Factors”, “Psychological Factors”, “Risk Factors”, “PPD”, and “Women”. The study followed PRISMA guidelines. Two reviewers independently performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa scale (NOS). Disputes were resolved by consensus. Meta-analysis was conducted using the Restricted Maximum Likelihood (REML) method, with heterogeneity quantified using I2 and examined through meta-regression, subgroup analyses, and sensitivity analyses. Publication bias was assessed using a funnel plot.

resultsThe systematic review included 32 articles, of which 23 were included in the meta-analysis. The key findings revealed that a history of depression (CI 95% = 1.59 to 7.85, P < 0.002, OR = 3.53) and stress during pregnancy (OR = 2.20, 95% CI: 1.62–3.00, P < 0.001) had significant relationships with PPD. Income showed an indirect and significant relationship with PPD (CI 95%, -0.171 to -2.312, P < 0.021, r=-0.093). Unwanted or unplanned pregnancy (CI 95%, 0.01–0.12, P < 0.02, r = 0.067) had a direct and significant relationship with PPD. The relationship between social support and PPD was significant (CI 95%, -0.187 to -0.033, P < 0.005, r = -0.11), indicating an indirect and significant effect. The relationship between partner support and PPD was estimated (CI 95%, -0.141 to -0.007, P < 0.001, r=-0.089). The results showed that social support, specifically partner support, has an indirect and significant linear relationship with PPD. The results showed that mothers who were employed themselves or had an employed partner had half the odds of developing PPD compared to those without employment (OR = 0.5, 95% CI: 0.066–0.38, P < 0.001), indicating a strong protective effect. The results showed that the type of delivery was inversely linearly associated with PPD; however, the statistical significance of this association was not reported (CI 95%, -0.113 to 0.018, P < 0.152) r=-0.048).

conclusionsThe meta-analysis of 23 studies demonstrated that a history of depression and prenatal stress were the strongest predictors of postpartum depression (PPD), with ORs of 3.53 and 2.20, respectively. Income showed a significant inverse association with PPD, while unwanted pregnancy had a direct positive relationship. Both general social support and partner support exhibited significant protective effects. Additionally, maternal or partner employment reduced the odds of PPD by half, indicating a substantial protective role. In contrast, the type of delivery showed an inverse but statistically nonsignificant association with PPD. PROSPERO REGISTRATION NUMBER: CRD42023425869