Lifetime Difficulty Experiences and Postpartum Depressive Symptoms: A Retrospective Cohort Study

Purpose To investigate whether adverse life experiences are associated with postpartum depressive symptoms at 1 month, and to examine dose–response relationships and specific types of adversity. Methods We conducted a retrospective cohort study at a tertiary perinatal center in Japan. Women who delivered at ≥ 22 weeks’ gestation between 2018 and 2024 were eligible. At the first prenatal visit, women completed a routine questionnaire assessing adverse life experiences. For analysis, the experiences were grouped into seven categories. Postpartum depressive symptoms were assessed at the routine 1-month postpartum visit using the Edinburgh Postnatal Depression Scale (EPDS), with a score ≥ 9 indicating depressive symptoms. Multivariable logistic regression models were fitted to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs), adjusting for covariates. Results Among 6,559 women included in the primary analysis, 4,197 (63.1%) reported at least one adverse life experience. Postpartum depressive symptoms occurred in 7.2% of women with any adverse life experience compared with 4.5% of those with none. Any adverse life experience was associated with higher odds of postpartum depressive symptoms (aOR 1.55, 95% CI 1.24–1.96). A clear dose–response relationship was observed, with increasing odds of postpartum depressive symptoms as the number of adverse experience categories increased (P for trend < 0.001). Personal health problems were independently associated with postpartum depressive symptoms (aORs 1.60, 95% CI 1.16–2.20). Conclusions Adverse life experiences were associated with an increased risk of postpartum depressive symptoms in a dose-dependent manner. In particular, personal health problems were associated with postpartum depressive symptoms.