Mental health during pregnancy and the postpartum period
A key to the health of both mother and child
For many years, perinatal research has primarily focused on somatic complications. The publication “Recent advances in the study of perinatal mental health: Epidemiology, psychopathology and intervention,” published in Advances in Clinical and Experimental Medicine, a journal of Wroclaw Medical University, clearly demonstrates that a mother’s mental state is an equally important dimension of maternal health.
The authors of the article—Chong Chen and Shin Nakagawa from the Department of Neuropsychiatry, Division of Neurological Sciences, Yamaguchi University School of Medicine (Japan)—present perinatal mental disorders as a widespread phenomenon that is still too rarely recognized and treated with appropriate seriousness.
Dr Chong Chen, one of the authors, emphasizes:
“Although perinatal mental disorders are more common than many serious obstetric complications, in clinical practice, they are still often treated as transient emotional reactions. As a result, both mothers and medical professionals frequently fail to recognize early signals as symptoms requiring diagnosis and support.”
This statement opens a narrative about a phenomenon that, despite its high prevalence, still too often escapes the attention of healthcare systems.
Photo by Raymart Arniño on Unsplash
Photo by Raymart Arniño on Unsplash
Epidemiology: a larger scale than everyday practice suggests
The epidemiological data cited by the authors clearly show that perinatal mental disorders are among the most common complications of pregnancy and the postpartum period. It is estimated that prenatal depression affects approximately 15–20% of women, while postpartum depression occurs in 10–15% of mothers, with higher rates observed in many populations, particularly among groups exposed to social, economic, or health-related stressors. Difficulties in forming a bond with the infant, although less systematically monitored, are reported—depending on the assessment scale—by several to more than a dozen percent of women during the first year after childbirth.
The authors point out that the true scale of the problem is likely underestimated. Many women do not report symptoms due to fear of stigma, social judgment, or loss of perceived parental competence. In addition, depressive symptoms are often masked by fatigue, sleep deprivation, and physiological changes during the postpartum period, which contributes to their minimization by both patients and healthcare professionals.
Particularly alarming are data concerning maternal mortality. In high-income countries, mental disorders—including depression and suicide—are among the leading causes of death in women between 6 and 12 months after childbirth, surpassing many classical obstetric complications. The COVID-19 pandemic further highlighted the vulnerability of perinatal mental health to environmental factors such as social isolation, limited access to care, increased anxiety, and economic uncertainty.
Despite these data, clinical practice is still dominated by the belief that low mood, anxiety, or feelings of overload are “natural” elements of adaptation to motherhood. As a result, intervention often occurs only when symptoms reach a level that severely disrupts functioning.
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Psychopathological mechanisms: how does the disorder develop?
The authors describe the psychopathology of perinatal depression as the result of a complex interaction between biological, emotional, and social factors. Hormonal changes during pregnancy, altered sleep patterns, cultural pressure associated with the maternal role, and lack of support all create an environment in which normal adaptation may evolve into a mental disorder.
Particularly noteworthy are the links between postpartum depression and difficulties in bonding with the infant. Network analyses discussed by the authors show that these phenomena are not merely separate diagnostic categories but rather two manifestations of a single disturbed dynamic. In a study involving more than 5,000 women, four symptoms were identified that connect both disorders: fear, loss of pleasure, feelings of being overwhelmed, and insomnia.
As dr Chong Chen explains:
“In our study, these four symptoms emerged as key elements linking postpartum depression with bonding difficulties, regardless of whether six weeks, six months, or two years had passed since childbirth. They mark the point at which adaptation to motherhood ceases to proceed normally and begins to take the form of a clinical disorder.”
In the first months postpartum, self-harm thoughts and intensified self-criticism also play a particularly important role. Both symptoms indicate that the adaptation process has not only been disrupted but is also moving in a direction that requires urgent intervention.
Consequences: a disorder that affects both mother and child
The authors emphasize that perinatal mental disorders are not limited to the psychological well-being of the mother alone. Their consequences are relational, developmental, and long-term, affecting the child and the entire family environment.
In mothers, depression and heightened anxiety lead to impaired cognitive and emotional functioning, including difficulties with concentration, reduced emotional responsiveness, irritability, and feelings of being overwhelmed. In everyday infant care, this may result in reduced sensitivity to the child’s signals, limited capacity for emotional regulation, and greater instability in interactions. From the infant’s perspective, this represents a disruption of one of the key stress-regulation mechanisms—a secure and predictable relationship with the caregiver.
Studies cited in the publication indicate that children of mothers with untreated perinatal depression are at increased risk of language development delays, difficulties in emotional regulation, and behavioral problems later in childhood. From a neurobiological perspective, chronic disturbances in the caregiving relationship may influence the maturation of stress-response systems and brain structures responsible for emotional processing and adaptation to stress.
The consequences also have a social and systemic dimension. Untreated perinatal mental disorders are associated with increased healthcare utilization, reduced maternal workforce participation, difficulties in partner relationships, and a higher risk of mental disorders in subsequent pregnancies. In this sense, the authors stress that perinatal depression is not merely an episode of emotional crisis but a risk factor with long-term, intergenerational effects.
Interventions: the need for an integrated approach
One of the key conclusions of the publication is the need to move away from symptom-focused therapies toward integrated interventions that encompass the entire experience of motherhood. Perinatal depression does not exist in isolation—it is intertwined with the mother–child relationship, the quality of social support, physical burden, lifestyle, and a woman’s previous emotional experiences. Although effective treatment of depression often leads to improved maternal functioning and better mother–infant interaction, research increasingly shows that the most durable outcomes are achieved by programs that integrate multiple levels of intervention from the outset.
Such an approach combines classical psychotherapy targeting depressive symptoms with interventions aimed at strengthening the mother–child bond, systemic social and partner support, and lifestyle factors such as physical activity, sleep, circadian rhythm regulation, and contact with nature. Increasingly, these interventions are complemented by technological components: mood and activity monitoring applications, tools for early detection of symptom deterioration, and solutions supporting therapeutic contact between visits. Their role is not to replace the clinical relationship, but to enhance continuity of care and increase access to support at critical moments.
The challenge is that in many healthcare systems, care for women during the perinatal period remains fragmented. Responsibility is divided among obstetrics, pediatrics, psychiatric care, and primary healthcare, often without a shared plan or clear role delineation. In practice, this means that women—at one of the most demanding times of their lives—must navigate a system that was not designed to meet their complex needs.
Chong Chen draws attention to this issue, emphasizing that the lack of care coordination not only delays treatment but may also exacerbate feelings of loneliness and helplessness among mothers:
“Care for women during the perinatal period remains fragmented between obstetrics, pediatrics, and psychiatric services. As a result, mothers are forced to navigate a system that is not prepared for this task. Comprehensive support requires collaboration among multiple specialists and the creation of clear care pathways so that patients are not burdened with coordinating treatment on their own.”
The authors clearly state that the future of perinatal care should move toward family-centered models, in which psychological, relational, and health support is offered continuously, in a coordinated manner, and adapted to the changing needs of both mother and child—not only at times of crisis, but also as part of long-term prevention of mental health consequences for future generations.
The most effective interventions are those that integrate from the outset:
- psychotherapy focused on depression,
- interventions strengthening the mother–child bond,
- social and partner support,
- lifestyle components,
- and technological tools such as mood- and activity-monitoring applications.
Summary: a paradigm shift
The work of Chong Chen and Shin Nakagawa presents a clear message: perinatal mental disorders should be treated as an integral component of medical care, not merely as concerns raised in exceptional cases. Early diagnosis, culturally sensitive tools, collaborative, multidisciplinary interventions, and recognition of the mother–child relationship as an essential element of treatment are crucial.
This requires a shift in thinking—from a reactive to a proactive approach. If the goal of the healthcare system is to support not only survival but also the healthy development of both mother and child, it is necessary to create structures that recognize disorders early, respond effectively, and operate in an integrated manner. According to the authors, this direction should define the future of perinatal care.
A. Hasiak
FAQ: Mental health in the perinatal period
What are perinatal mental disorders?
Perinatal mental disorders encompass a spectrum of mental health problems occurring during pregnancy and up to 12 months postpartum. They most commonly include depression, anxiety disorders, and difficulties in forming the mother–child bond. In DSM-5 and ICD-11 classifications, the specifier “with perinatal onset” highlights the specific biological and psychosocial context of this period.
How common are mental disorders during pregnancy and the postpartum period?
Epidemiological studies indicate that prenatal depression affects approximately 15–20% of women, while postpartum depression occurs in 10–15%. Anxiety disorders may occur at similar or higher rates but are less frequently diagnosed. The true prevalence is likely underestimated due to cultural barriers, stigma, and limitations of screening tools. In high-income countries, mental disorders are among the leading causes of maternal death in the first year after childbirth.
What mechanisms underlie perinatal depression?
The psychopathology of perinatal depression is multifactorial and results from interactions between neuroendocrine changes (rapid fluctuations in sex hormones, alterations of the HPA axis), psychological factors (stress vulnerability, previous depressive episodes), and social determinants (social support, environmental burden). Increasing evidence also points to shared core symptoms linking depression and bonding difficulties.
How do perinatal mental disorders affect the mother–child relationship?
Depression and heightened anxiety may impair parental sensitivity, emotional regulation, and appropriate responsiveness to infant cues. This results in reduced interaction quality and synchrony. From a developmental perspective, such disturbances may affect attachment formation and the maturation of systems responsible for stress and emotion regulation.
What are the consequences of untreated disorders for mothers and children?
In mothers, untreated perinatal disorders increase the risk of chronic mood disorders, reduced social and occupational functioning, and relationship difficulties. In children, there is an elevated risk of language delays, emotional dysregulation, and behavioral problems. These effects may be intergenerational, giving them significant public health relevance.
What are the limitations of current diagnostic tools?
Commonly used screening scales, such as the EPDS, show good sensitivity but limited specificity and do not always distinguish between depression and anxiety. Tools assessing mother–infant bonding often lack clearly defined cut-off scores, limiting their clinical utility. The authors emphasize the need for multidimensional assessment instruments.
Which interventions are considered most effective?
The best outcomes are achieved with integrated interventions combining psychotherapy targeting depressive and anxiety symptoms, approaches that strengthen the mother–child relationship, social support, and—when indicated—pharmacotherapy. Digital tools supporting symptom monitoring and continuity of care are increasingly used as adjuncts.
What directions for the development of perinatal care do current studies suggest?
Current research advocates a shift from reactive to proactive models, including early risk identification, improved coordination of care among specialists, and family-centered approaches. Maternal mental health should be treated as an integral element of perinatal care and a key determinant of the health of future generations.
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About the journal:
(Adv Clin Exp Med) is an international, peer-reviewed journal that highlights the full translational pathway of biomedical research – from laboratory discoveries (“bench”), through clinical application (“bedside”), to real-world practice and policy (“implementation”). It welcomes original research articles, reviews/meta-analyses, clinical recommendations/guidelines, research-in-progress reports, research letters, and study protocols authored by recognized experts in the fields of clinical and experimental medicine. The journal is indexed in several databases, including Scopus, PubMed and Index Copernicus, as well as (since 2007) in Thomson Reuters databases – Science Citation Index Expanded and Journal Citation Reports/Science Edition. It has its Journal Impact Factor (JIF) calculated since the 2009 release of the Journal Citation Reports™. The journal “Advances in Clinical and Experimental Medicine" is owned and published monthly by Wroclaw Medical University.
This material is based on the article:
Authors: Chong Chen1, Shin Nakagawa1
1Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine
Advances in Clinical and Experimental Medicine
DOI: 10.17219/acem/212646
Web. A. Maj
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