Assessing the Prevalence of Maternal Mental Health Disorders Between Six Weeks and Six Months Postpartum—A Scoping Review

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However, they remain under-researched beyond the initial six weeks postpartum, especially in low- and middle-income countries (LMICs). The aim of this review was to document the global prevalence of PPD and related PMAD symptoms from six weeks to six months postpartum. Methods: A clinically-oriented search strategy was used to assess peer-reviewed articles published between 2019 and 2024 in PubMed, Embase, and CINHAL. Studies were screened by two independent reviewers for inclusion if they presented primary data around the prevalence of PPD and/or related PMADs from six weeks to six months postpartum (inclusive). Key elements (e.g., country, PMADs measured, measurement interval, prevalence rate) were extracted using Covidence and analyzed in StataBE. Results: Most of the 80 included studies were from high-income and middle-income countries (92.50%) and only measured PPD during the six-to-eight week postpartum interval (53.75%). The median prevalence rates for symptoms of all disorders and PPD were 13.20% and 16.00%, respectively. Rates of PPD symptoms ranged from 0.00% to 76.60% and were most often measured with the Edinburgh Postnatal Depression Scale (EPDS). Cut-off scores used for the EPDS ranged from 9 to 14 with a median of 11, but they were reported inconsistently. Conclusions: The median prevalence rate (16.00%) of PPD symptoms in this study is consistent with rates found in other studies, indicating that PPD persists beyond the immediate postpartum period. However, this study identified the need for more comparable prevalence data: from LMICs, focusing beyond six-to-eight weeks postpartum, and including disorders other than PPD. Future systematic reviews and qualitative analyses are needed to explore PMAD prevalence rates with more rigor and culturally sensitive concepts. Postpartum depression anxiety post-traumatic stress disorder obsessive-compulsive disorder mental health prevalence perinatal maternal health Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Background Mental health is a critical aspect of pregnancy and the first three years postpartum ( 1 – 4 ). Within the field of perinatal mental health, psychological disorders predominate the literature given their prevalence and severity ( 5 ). Such disorders, called perinatal mood and anxiety disorders (PMADs), include perinatal depression, anxiety, psychosis, bipolar disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD) ( 5 – 8 ). These disorders are primary causes of morbidity and mortality among pregnant and postpartum people worldwide ( 1 , 2 , 4 , 9 , 10 ). The literature reports that perinatal depression and anxiety are the most commonly experienced PMADs ( 11 ). Global estimates indicate that up to one-in-six perinatal people experience perinatal depression and/or anxiety ( 6 , 8 ). In the postpartum period, the prevalence of bipolar disorder has been reported at 3.3% to 25.5%, OCD at 2% to 24%, PTSD at 0% to 43%, and psychosis at 0.089% to 0.5% ( 12 – 15 ). Some of these rates exclude people with existing symptoms, despite the risks postpartum people with pre-existing mental health conditions face for continued or exacerbated symptoms ( 16 ). For example, review of the literature indicates that up to 70% of women with preexisting OCD experience a worsening of symptoms in the perinatal period ( 13 ). Adverse mental health outcomes associated with perinatal depression and other PMADs may persist for up to three years postpartum, driven by a complex interplay of contextual, intersecting, and multi-level factors ( 3 , 8 , 17 – 19 ). These include biological, psychological, and social variables, including hormonal and genetic factors, stress, and experiences of social support and/or violence ( 8 , 19 – 21 ). For example, estrogen and progesterone levels drop significantly in the first few days postpartum—a hypothesized contributor to the subsyndromal condition, postpartum blues ( 22 – 27 ). The hormones then fluctuate but typically normalize by the last postpartum visit at six-to-eight weeks postpartum, though hormone trajectories are influenced by factors such as age and breastfeeding status ( 22 , 24 – 29 ). Such hormonal shifts have been implicated in one’s risk for developing postpartum depression (PPD) ( 22 – 26 ). While some risk factors may have more influence on mental health in the first six weeks postpartum—when the onset of PPD is classified—other factors, e.g., lack of social support, continue and/or are exacerbated beyond the sixth week after giving birth ( 3 – 5 , 30 – 35 ). Despite the continuance of these risk factors, there is a comparative lack of research on such mental health topics beyond six to 12 weeks postpartum ( 8 , 33 , 36 , 37 ). In addition to common risk factors, individual experiences of PMADs vary significantly by geographic region and country income level ( 38 – 42 ). For example, studies show that some populations in sub-Saharan Africa may describe symptoms of depression, including perinatal depression, more somatically or through “thinking too much” rather than a new lack of interest in doing things ( 39 , 41 , 43 , 44 ). Additionally, despite the global prevalence and diversity of PMADs, there is a lack of literature about them from low- and middle-income countries (LMICs) compared to high-income countries (HICs) ( 8 , 32 ). This is concerning, as reported rates of PPD have been lower in HICs compared to LMICs ( 3 , 8 , 45 ). Commonly utilized instruments to measure PMAD symptoms, specifically those of PPD and postpartum anxiety, include the 10-item Edinburgh Postnatal Depression Scale (EPDS), the nine-item Patient Health Questionnaire (PHQ-9), and the seven-item Generalized Anxiety Disorder Scale (GAD-7) ( 46 – 48 ). These and other screening tools use one or more cut-off scores to delineate between levels of symptom severity and/or presence/absence of (probable) mental health disorders, depending on the researcher’s interpretation of their results ( 49 – 52 ). While the gold standard for mental health disorder assessments is diagnosis by a qualified medical professional, access to such professionals may not be possible in all regions and research studies ( 53 , 54 ). Another consideration is that although mental health screening tools are useful, they have also been critiqued for their lack of cross-cultural relevance in capturing people’s symptoms ( 44 , 53 , 55 – 57 ). It is evident that PPD and additional PMADs are of critical importance in the postpartum period but under-researched (i) beyond six weeks postpartum and (ii) in LMICs. Therefore, the aim of this review was to document the global prevalence of PPD and related PMAD symptoms from six weeks to six months postpartum. Methods This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, ensuring adherence to best practices for systematically identifying, selecting, and mapping relevant evidence ( 58 , 59 ). Eligibility Criteria, Information Sources, and Search Eligible sources included peer-reviewed, indexed, primary research articles published between 2019 and 2024 in English. A clinically-oriented search strategy was developed in collaboration with a medical librarian at the University of California San Francisco (Table 1 ). The initial search string was designed for PubMed and subsequently adapted for Embase and CINAHL (Supplementary Material 1). Searches incorporated both ‘All Fields’ terms and controlled vocabularies (MeSH and Emtree) to maximize sensitivity and capture the breadth of relevant literature. The database searches were conducted on July 23, 2024. Following full-text screening, reference lists of relevant review articles populated through the search strategy were examined using snowball sampling. Articles identified from reference lists via snowball sampling were subjected to the same eligibility screening and review process as the original dataset. Table 1 PubMed Search String Search term Variations of search terms Field Postpartum depression (("depression, postpartum") OR (("postpartum" OR "postnatal" OR "post-partum" OR "post-natal") AND depress*)) MeSH; Title/abstract AND Incidence/ prevalence ("incidence" OR "prevalence" OR diagnosis* OR treat* OR screen*) Title/abstract AND Clinical inquiry ((Therapy/Broad[filter]) OR (Diagnosis/Broad[narrow])) Filter AND Article criteria English Past 5 years (2019–2024) Filter Selection of Sources of Evidence Citations from all databases were exported into Covidence, an online platform for managing systematic reviews ( 60 ). Following deduplication, the title/abstract screening of the articles were completed by two independent reviewers, with a third resolving conflicts, such as around inclusion/exclusion criteria. Reviewers relied on an a-priori set of inclusion and exclusion criteria (Table 2 ) to identify quantitative research studies with an incidence and/or prevalence measure of mental health diagnoses among postpartum persons between six-weeks and six-months postpartum (inclusive). The same screening process—two independent reviewers with a third resolving conflicts— and criteria were used for the full-text review. Both incidence and prevalence were included in this scoping review because the terms have been used interchangeably in the literature ( 61 – 68 ). Therefore, “prevalence” is referred to throughout this paper as inclusive of both measures: the focus of this study was not to differentiate between these two rates but to understand the overall rate of PPD and related PMADs. Additionally, the reviewers excluded studies that included only samples of people estimated or known to have higher rates of mental health disorders. Including such studies, such as those including only postpartum people with histories of mental health disorders, could inflate the overall prevalence rate reported in the results. When studies included populations hypothesized to have higher rates of mental health disorders alongside a control group, data from the latter were included in this study. Such studies may not have had a primary focus on PMADs but still measured and reported on them. Table 2 Inclusion and Exclusion Criteria Category Inclusion Exclusion Population Postpartum people who are between six weeks and six months postpartum (inclusive) Entire sample hypothesized to have higher rates of postpartum mental health disorders (e.g., all had previously diagnosed mental health disorders) Study type Cohort, cross-sectional, case-control studies, intervention studies with control group Intervention studies with no control group, protocols, qualitative studies, case studies, reviews, commentaries Outcome Incidence and/or prevalence for postpartum mental health diagnoses or symptoms measured with a validated tool between six weeks to six months postpartum (inclusive) Measurement of only mental health symptom severity (not prevalence/incidence) Publication Characteristics Full-text in English available No full-text in English available Data Collection and Extraction After full-text screening, one reviewer independently extracted data from the included articles in Covidence into a Microsoft Excel sheet ( 60 , 69 ). The reviewer extracted data for 15 key variables (Table 3 ) from each included article, including publication year, study design, screening tools implemented, and prevalence/incidence rates among others. Country income and world region were determined by the 2025 fiscal year World Bank country classifications ( 70 ). Table 3 Extraction Variables 1. Author(s), year 6. Study aim 11. Postpartum periods measured 2. Title 7. Study design 12. Mental health disorders examined 3. Journal 8. Inclusion criteria 13. Screening/diagnosis tools used 4. Country and country income level 9. Exclusion criteria 14. Screening/diagnosis tool cut-off scores 5. World region 10. Sample characteristics 15. Prevalence/incidence rates Several factors were considered when extracting data for this review. First, when multiple cut-off scores were used, data for all cut-off scores considered beyond “borderline” symptoms/disorders were extracted. When in doubt of the cut-off scores used, the researchers contacted the study authors (eight authors emailed). Second, in cases in which the entire sample was disaggregated by postpartum interval (e.g., 0–3 months, 3–6 months, etc.) only data for subgroups within the six weeks to six months were extracted. Third, unweighted or weighted results were reported based on the provided data. The unweighted data were extracted for one study that used inverse probability weighting to adjust for attrition bias, which aligned with the aim to represent overall findings, not more advanced analyses relevant for a meta-analysis ( 71 ). Fourth, aligning with many scoping review designs, study quality was not systematically assessed ( 72 , 73 ). Synthesis of Results Data cleaning included categorizing the postpartum periods measured (when and how often), consolidating inclusion/exclusion criteria, and standardizing the cut-off score reporting in a new variable. While screening and diagnosis tools and their respective cut-off scores were extracted as reported, some studies deviated in the way they reported their cut-off scores—a finding highlighted in the results. Descriptive statistics were used to summarize the data: the number of studies, their countries, regions, country income levels, study designs, study topics (based on study aim), and number of total samples. Each individual measurement of postpartum mental health symptoms counted as a sample. For example, a study that measured postpartum anxiety symptoms at two different time periods (e.g., at two and three months) would have two samples. Similarly, a study that measured one time period but reported prevalence rates based on two different cut-off scores (e.g., 10 and 12 on the EPDS) would also have two samples. Once data cleaning was completed, the data were exported to StataBE for analysis ( 74 ). Using the total samples (i.e, number of measurements), the minimum, maximum, median, and interquartile range (IQR) were calculated for the positive prevalence rate of symptoms for all disorders and for PPD specifically. The EPDS cut-off scores used to measure PPD symptoms were also descriptively summarized. Results A total of 1,606 unique studies were captured and screened during the initial title/abstract review (Fig. 1 ). Two-hundred-twenty-eight publications met inclusion/exclusion criteria and were reviewed in full-text, among which 148 were excluded. The most common reason for exclusion was that studies did not meet the population inclusion criteria (n = 119, 80.41%), including studies without data specific to people six weeks to six months postpartum (n = 78, 52.70%). A total of 80 studies met all criteria and were included in this study ( 7 , 49 – 51 , 61 , 62 , 64 – 68 , 71 , 75 – 142 ). Study characteristics The 80 included studies (Supplementary Material 2) were conducted across 40 unique countries (Fig. 2 ) ( 7 , 49 – 51 , 61 , 62 , 64 – 68 , 71 , 75 – 142 ). Based on World Bank definitions, the studies were most frequently located in East Asia and the Pacific (n = 28; 35.00%), followed by Europe and Central Asia (n = 20; 25.00%), sub-Saharan Africa (n = 10; 12.50%), North America (n = 8; 10.00%), Middle East and North Africa (n = 7; 8.75%), South Asia (n = 5; 6.25%), and Latin America and the Caribbean (n = 2; 2.50%) ( 7 , 49 – 51 , 61 , 62 , 64 – 68 , 71 , 75 – 142 ). A plurality came from China with 16 studies (20.00%), then six (7.50%) from the United States (U.S.), and four (5.00%) from India, followed by Ethiopia, France, Iran, Italy, and Norway (n = 3; 3.75% each) ( 49 , 50 , 62 , 64 – 68 , 71 , 83 , 88 , 89 , 91 , 93 , 99 , 100 , 105 , 107 , 109 – 111 , 113 , 115 , 118 , 120 – 124 , 126 – 129 , 131 , 134 , 136 – 141 ). Thirty-four (42.50%) of studies came from HICs, 28 (35.00%) from upper middle-income countries (MICs), 12 (15.00%) from lower MICs, and 6 (7.50%) from low-income countries (LICs) ( 7 , 49 – 51 , 61 , 62 , 64 – 68 , 71 , 75 – 142 ). The studies differed in their sample sizes and postpartum participant characteristics. The range of studies’ total sample sizes ranged from 50 to 90,194 with a median of 430 people ( 97 , 108 , 112 , 116 ). Study participants’ ages ranged from 12 to 53, with a median average study age of 30 ( 78 , 80 , 132 ). Participants in most studies were married and/or living with a partner, with a median reported study value of 95.31% (range of 7.22% to 100.00%) ( 7 , 49 , 78 , 79 , 84 , 91 , 99 , 116 , 142 ). Studies ranged from only including primiparous participants to only multiparous ones, with the median percentage of multiparous participants of 52.85% ( 64 , 68 , 84 , 90 , 100 , 102 , 117 , 131 , 134 , 137 ). The range of participants in each study who had completed at least high school ranged from 9.20% to 100.00%, with a median reported value among studies of 82.35% ( 80 , 84 , 89 , 107 , 110 , 130 ). Participant employment among studies also differed, but the majority of participants were unemployed and/or homemakers, ranging from 5.00–94.00% with a median value of 39.00% ( 66 , 112 , 128 ). Approximately half of the studies utilized a cohort design (n = 41; 51.25%), followed by cross-sectional (n = 24; 30.00%), experimental (n = 13; 16.25%), case-control (n = 1; 1.25%), and instrument validation (n = 1; 1.25%) ( 7 , 49 – 51 , 61 , 62 , 64 – 68 , 71 , 75 – 142 ). Over half of studies (n = 47, 58.75%) examined the association between one or more specific risk factor(s) and PMAD symptoms, followed by 23.75% (n = 19) that explored symptom prevalence and overall risk factors ( 49 – 51 , 61 , 62 , 64 , 65 , 67 , 68 , 71 , 75 – 81 , 84 , 86 – 91 , 93 , 94 , 96 – 111 , 113 – 120 , 123 , 125 , 127 – 129 , 131 – 135 , 137 – 140 , 142 ). Three studies (3.75%) examined types and/or trajectories of symptoms, one study (1.25%) validated a screening tool, and 10 studies (12.50%) explored more than one category above (e.g., both symptom trajectories and their association with one specific risk factor) ( 7 , 66 , 82 , 83 , 85 , 92 , 95 , 112 , 121 , 122 , 124 , 130 , 136 , 141 ). Almost half of studies excluded potential participants with a personal or family history of mental health disorders (n = 37; 46.25%) ( 50 , 51 , 61 , 64 – 66 , 68 , 75 , 79 , 82 , 84 – 86 , 88 , 92 , 99 , 103 , 105 – 110 , 113 , 114 , 117 , 119 , 122 – 124 , 134 , 137 – 142 ). However, there were also data from four observational studies including people with somatic diagnoses (5.00%; e.g., patients who were normotensive versus those who had preeclampsia) among the included articles ( 91 , 113 , 115 , 125 ). In such cases, these studies were exploratory rather than based on prior assumptions of the sample population(s) having higher rates of PMAD symptoms than the general population ( 91 , 113 , 115 , 125 ). The vast majority of studies (n = 78, 97.50%) measured depressive symptoms, using screening tools such as the EPDS (n = 65, 83.33%), PHQ-9 (n = 4; 5.13%), clinical interviews (n = 3; 3.85%), Center for Epidemiologic Studies Depression Scale (CES-D) (n = 2; 2.56%), Quick Inventory of Depressive Symptomatology (QIDS) (n = 1; 1.28%), or more than one of the above (n = 3; 3.85; Fig. 3 ) ( 49 – 51 , 61 , 62 , 64 – 68 , 71 , 75 – 120 , 122 – 142 ). Seventy-three of the studies (91.25%) measured symptoms of PPD alone ( 49 – 51 , 61 , 62 , 64 – 68 , 71 , 75 – 84 , 86 – 95 , 97 , 99 – 118 , 120 , 122 – 124 , 126 – 142 ). Five studies (6.25%) measured symptoms of depression and other mental health disorders, including anxiety (n = 2, 2.50%), PTSD (n = 1, 1.25%), both anxiety and PTSD (n = 1, 1.25%), and postpartum adjustment disorder (n = 1, 1.25%) ( 85 , 96 , 98 , 119 , 125 ). Two studies (2.50%) measured OCD symptoms only ( 7 , 121 ). Studies used the anxiety subscale of the 90-item Symptom Checklist (SCL-90), EPDS-3A, and GAD-7 (n = 1, 33.33% each) to measure anxiety symptoms ( 98 , 119 , 125 ). The 16-item Harvard Trauma Questionnaire (HTQ-16) and Posttraumatic Diagnostic Scale (PDS/PDS-5) (n = 1, 50.00% each) were used to measure PTSD ( 96 , 125 ). Clinical interviews were used to capture OCD symptoms (n = 2, 100.00%) and adjustment disorder symptoms (n = 1; 100%; Fig. 4 ) ( 7 , 85 , 121 ). Studies differed in when and how often they measured postpartum mental health symptoms. The majority of studies (N = 63, 78.75%) included samples from only one postpartum interval, mostly within the six-to-eight week time period (n = 43, 53.75%; Fig. 5 ) ( 49 – 51 , 61 , 62 , 64 – 68 , 71 , 75 – 85 , 87 – 92 , 97 , 99 – 107 , 111 – 113 , 115 , 118 , 119 , 121 – 125 , 127 – 129 , 131 – 135 , 137 – 142 ). Others measured the same or different samples from two (n = 14, 17.50%), or three or more postpartum intervals (n = 3, 3.75%) ( 7 , 86 , 93 – 96 , 98 , 108 – 110 , 114 , 116 , 117 , 120 , 126 , 130 , 136 ). Among the studies that measured their samples in multiple time intervals, almost half (n = 8, 10.00% of total studies) included a six-to-eight week measurement, and a little over half did not (n = 9, 11.25% of total studies) ( 7 , 86 , 93 – 96 , 98 , 108 – 110 , 114 , 116 , 117 , 120 , 126 , 130 , 136 ). Across the included studies, there were 145 postpartum samples—due to some studies (i) reporting prevalence rates disaggregated by subgroups only rather than the entire sample (n = 12, 15.00%), (ii) measuring the same or different samples at multiple time periods (n = 17, 21.25%), and/or (iii) reporting more than one rate using multiple cut-off scores and/or instruments for the same or different disorders (n = 11 ,13.75%) ( 86 , 91 , 100 , 112 , 114 , 115 , 125 – 127 , 131 , 132 , 141 ). Among the total samples, 125 were for depression, 10 for OCD, five for anxiety, four for PTSD, and one for adjustment disorder. Thirty-eight (26.21%) of 145 samples were based on findings from control groups only. Eighty (55.17%) of the samples included total study participants, and the remaining 27 samples (18.62%) were subgroups of total samples or ‘intervention’ groups in observational studies. The reported sample sizes of measurements ranged from 26 to 38,030, with a median of 266 ( 79 , 112 , 115 ). Across samples, the prevalence rates of PMAD symptoms ranged from 0.00% (n = 4) to 76.60% (n = 1), with a median of 13.20% and an IQR of 12.20% ( 95 , 96 , 103 , 116 ). Among the 125 samples assessed for depression, the prevalence rates of symptoms had the same range (0.00% (n = 2) to 76.60% (n = 1)), a median of 16.00%, and an IQR of 11.60% (Fig. 6 ) ( 96 , 103 , 116 , 143 ). The majority of samples assessed for depression were measured with the EPDS (n = 101; 80.80%), followed by the PHQ-9 (n = 12; 9.60%), clinical/diagnostic interviews (n = 5; 4.00%), the QIDS (n = 4; 3.20%), and the CES-D (n = 3; 2.40%). Among samples measured with the EPDS alone, the median prevalence rate was 16.40% with an IQR of 10.50%. The minimum (0.00%) and maximum (76.60%) prevalence for samples of depressive symptoms were measured with the EPDS. Studies (n = 68) varied in how they reported and used EPDS cut-off scores ( 49 – 51 , 61 , 62 , 64 – 68 , 71 , 75 – 84 , 86 , 88 – 95 , 97 – 103 , 105 – 114 , 116 – 119 , 122 – 125 , 128 – 134 , 138 – 142 ). Studies reported the EPDS cut-off scores they used inclusively (i.e., x score or higher or ³x score; n = 59, 86.76%), exclusively (i.e., greater than x score or > x score; n = 6, 8.82%), not explained (e.g., cut-off of x; n = 1, 1.47%), or not at all (n = 2, 2.94%). Sixteen (23.53%) studies reported the EPDS cut-off scores they used in multiple ways ( 50 , 64 , 77 , 84 , 88 , 89 , 97 , 107 , 109 – 113 , 122 , 134 , 141 ). These 16 studies reported EPDS cut-off scores in “³x” and “(x-1)/x” formats or reporting an inclusive cut-off score but using the shorthand of “>x” (exclusive) rather than “³x” (inclusive), the latter introducing inconsistencies ( 50 , 64 , 77 , 84 , 88 , 89 , 97 , 107 , 109 – 113 , 122 , 134 , 141 ). Additionally, one study considered a positive EPDS cut-off score as ³10 or thoughts of self-harm ( 116 ). After standardizing each cut-off score to be inclusive when possible (excluding the scores that were non-reported, not indicated as exclusive or inclusive, or combined with thoughts of self-harm), samples’ EPDS cut-off scores (n = 94) ranged from 9 to 14, with a median of 11 and an IQR of 3 ( 49 – 51 , 61 , 62 , 64 – 67 , 71 , 75 – 84 , 86 , 88 – 95 , 97 – 103 , 105 – 114 , 117 – 119 , 122 – 125 , 128 – 134 , 136 , 139 – 142 ). The respective EPDS cut-off score ranges, medians, and IQRs varied by region, country income level, and postpartum measurement timeframe (Table 4 ). Table 4 EPDS cut-off scores by region, country income level, and postpartum measurement timeframe Category (number of samples) Cut-off score range Cut-off score median Cut-off score IQR World Region East Asia and Pacific (n = 32) 9–13 10 0.5 Europe and Central Asia (n = 29) 10–13 10 3 Latin America and the Caribbean (n = 3) 10–11 10 1 Middle East and North Africa (n = 13) 10–13 13 1 North America (n = 3) 10–13 11 3 South Asia (n = 4) 10–13 12.5 2 Sub-Saharan Africa (n = 10) 10–14 13 1 Country Income Level LIC (n = 7) 10–14 13 1 Lower MIC (n = 15) 10–13 13 1 Upper MIC (n = 27) 9–13 10 1 HIC (n = 45) 9–13 10 3 Postpartum Measurement Timeframe 6–8 weeks (n = 45) 9–14 11 2 9 weeks-3 months (exclusive) (n = 4) 12 12 0 3 months (inclusive)-6 months (n = 40) 9–13 10 3 Other (n = 5) 9–13 10 3 Lastly, given the small sample size for samples assessed for OCD, anxiety, PTSD, and adjustment disorder, amalgamated median and IQR were not calculated. The ranges of reported rates were 6.00–9.00% for OCD, 3.00-16.70% for anxiety, and 0.00–2.00% for PTSD ( 7 , 96 , 98 , 119 , 121 , 125 ). The one sample assessed for adjustment disorder had a prevalence rate of 15.00% ( 85 ). Discussion The median prevalence rate of PMAD symptoms occurring between six weeks and six months postpartum (inclusive) was 13.20% (IQR = 12.20%). The median prevalence rate for PPD symptoms during this timeframe was 16.00% (IQR = 11.60%). The rate of PPD symptoms found in this study is similar to that found through a seminal meta-analysis on the disorder (17.22%) ( 8 ). However, the median prevalence rate for all PMAD symptoms was higher than that reported for meta-analyses examining postpartum anxiety disorders (8.50%), OCD (6.20%), and PTSD (3.10%) ( 144 – 146 ). This discrepancy may be due to the overrepresentation of samples assessed for PPD symptoms (125 of 145 samples). The median prevalence rates of symptoms of anxiety, OCD, and PTSD identified in this review were closer to those rates. Overall, the median prevalence rates identified through this review indicate that PMAD, including PPD, symptoms continue beyond six weeks postpartum, necessitating interventions after individuals’ last recommended postpartum visit ( 147 ). Other important findings identified through this review were the unexpected range of PPD prevalence rates and unstandardized EPDS cut-off score reporting. The prevalence of PPD symptoms ranged from 0.00% to 76.60% ( 96 , 103 , 116 ). Neither of these rates, all identified within control groups of 64–119 participants, align with established literature on PPD ( 3 , 38 , 148 ). Based on these discrepancies, the methodological quality of some studies included in this review may need to be examined. This concern about study quality also applies to EPDS use in this study. The EPDS measures symptoms of anhedonia (lack of enjoyment and laughter), anxiety (blaming oneself, worry, panic, trouble coping), and depression (sleeping difficulties, sadness, crying, thoughts of self-harm) ( 48 , 149 ). The screening tool’s cut off scores often range from 10 to 13 ( 150 ). In this study, the range of inclusive EPDS cut-off scores ranged from 9 to 14, with a median cut-off score of 11. Cut-off scores differ based on the desired sensitivity/specificity of the tool, the severity of symptoms measured, and applicability to local cultural contexts ( 151 – 153 ). While cut-off scores are useful for clinical practice and research studies, there are errors in using validated cut-off scores that are: (i) incorrectly interpreted, (ii) based on a different cultural group or gender, (iii) derived from frequently used cut-off scores (which over-represent English-speaking samples), and (iv) aggregated across various samples ( 154 ). In addition, this study identified the pitfalls of describing cut-off scores in different ways. Cut-off scores for the EPDS were reported inclusively, exclusively, not specified as inclusive or exclusive, not at all, or in multiple ways. This creates confusion and limits comparability across studies. Clear reporting of cut-off scores is needed for tangible clinical applications of PMADs research ( 151 , 152 , 154 , 155 ). Other gaps identified through this scoping review were the lack of LIC representation, emphasis beyond six-to-eight weeks postpartum, and focus on understanding a broader baseline prevalence rate of PMADs. Only six studies from LICs were identified in this review, indicating a need for more research representing postpartum people’s experiences in these countries, aligning with prior research ( 21 , 32 , 156 ). For example, there are ongoing discussions in the literature about how the current use of PMAD screening instruments does not adequately capture people’s experiences and understandings of mental health in LICs and other LMICs ( 39 , 44 , 154 ). Moreover, over half of the studies only included samples from the six-to-eight week postpartum interval ( 49 – 51 , 61 , 64 – 68 , 71 , 76 , 78 , 80 , 82 – 84 , 86 , 89 , 90 , 93 , 97 , 99 , 100 , 102 , 103 , 106 , 111 , 114 – 116 , 118 , 122 – 124 , 126 – 132 , 134 – 140 , 142 ). This finding is concerning, as it continues to demonstrate that there is a comparative lack of research on PMADs beyond six to 12 weeks postpartum, even when a study is specifically looking for those later postpartum intervals ( 8 , 33 , 36 , 37 ). Lastly, almost half of the samples analyzed in this review were based on control groups, intervention groups in observational studies, and subgroups. This means that almost half of studies were focusing on specific groups of people rather than trying to identify a broader baseline rate of PMAD symptoms, a baseline which is needed to understand the burden of PMADs in the general population ( 157 , 158 ). While this study provides valuable insights on the prevalence of PPD and related PMADs occurring from six weeks to six months postpartum, it is not without limitations. First, the search strategy and results mostly center on PPD, including no analyses of postpartum psychosis. The overrepresentation of PPD results occurred despite the snowball sampling of citations and the resulting inclusion of 78 articles included in this review. Unfortunately, this lack of focus on PMADs other than PPD is evident in the broader perinatal mental health literature as well ( 159 – 161 ). For example, a simple PubMed search populated 15,428 results for “postpartum depression,” 5,546 for “postpartum anxiety,” and 222 for “postpartum obsessive-compulsive disorder” on September 9, 2025 ( 162 – 164 ). Another limitation of this study is that the reported rates reflect symptoms of or risks for PMADs, based on the use of validated screening tools or diagnostic methods, rather than confirmed clinical diagnoses in all cases ( 54 ). However, only six of 145 samples analyzed in this review were measured using diagnostic clinical interviews. Therefore, many of the data would be missing if only strict clinical diagnoses were included ( 53 , 54 ). Despite these limitations, this is the first study to investigate the rate of PPD and related PMADs occurring from six weeks to six months postpartum—research needed to inform clinical identification and treatment. Further, this study has highlighted gaps across PMAD measurements, including inconsistent reporting of screening tool cut-off scores used. This study’s findings are informative for researchers, clinicians, and policymakers to understand that PPD and related PMADs persist in the postpartum period beyond six weeks postpartum. Researchers may use these findings to inform further investigations of PMADs occurring after the immediate postpartum period, including the cross-cultural relevance of screening tools and cut-off scores. Both clinicians and policymakers can use the results of this scoping review to develop more targeted patient care practices and policies for patients who are six weeks to six months postpartum. Future systematic reviews and meta-analyses should be used to capture study quality and weighted prevalence and incidence rates. Future reviews should also examine and address risk factors associated with PMADs after six weeks postpartum. Qualitative studies are needed to understand postpartum people’s experiences and understandings of PMADs, particularly from LICs, for which the current quantitative research is scarce. Conclusions The results of this study indicate that PPD persists in the postpartum period beyond the last postpartum visit around six weeks postpartum. This study also identified the need for more comparable prevalence data: from LICs, focusing beyond six-to-eight weeks postpartum, and including disorders other than PPD. Importantly, the reporting of cut-off scores for PMAD screening instruments should be standardized in the literature to prevent confusion and facilitate comparability. Future systematic reviews and qualitative analyses are needed to explore PMAD prevalence rates with more rigor and culturally-informed perspectives. Abbreviations CES-D- Center for Epidemiologic Studies Depression Scale EPDS- Edinburgh Postnatal Depression Scale GAD-7- Generalized Anxiety Disorder Scale HIC- High-Income Country HTQ-16- Harvard Trauma Questionnaire IQR- Interquartile Range LIC- Low-Income Country LMICs- Low- and Middle-Income Countries Lower MIC- Lower Middle-Income Country OCD- Obsessive-Compulsive Disorder PDS/PDS-5- Posttraumatic Diagnostic Scale PHQ-9- Patient Health Questionnaire PMADs- Postpartum Mood and Anxiety Disorders PPD- Postpartum Depression PRISMA-ScR- Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews PTSD- Post-Traumatic Stress Disorder QIDS- Quick Inventory of Depressive Symptomatology SCL-90- Symptom Checklist Upper MIC- Upper Middle-Income Country Declarations Clinical trial number Not applicable. Ethics approval and consent to participate No Institutional Review Board approval was needed for this study, as it was a review of the literature without any direct involvement of human participants. Consent for publication Not applicable. Availability of data and materials The datasets used in the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This review was funded by the Leavitt Family Fund and the Wyss Medical Foundation. The funders had no roles in nor influence on the manuscript. Authors' contributions EB conducted the study’s search, title/abstract and full-text screening, data extraction, data analysis, and manuscript writing. AM, MRL, and SB were also reviewers during title/abstract screening. AM was the second reviewer for the full-text screening. PBG, KB, AB, and FFJ provided the conceptualization and general oversight for this review. 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Cambridge ; New York: Cambridge University Press; 2010. 736 p. Baumeister H, Härter M. Prevalence of mental disorders based on general population surveys. Soc Psychiatry Psychiatr Epidemiol. 2007 July 1;42(7):537–46. Burton HAL, Pickenhan L, Carson C, Salkovskis P, Alderdice F. How women with obsessive compulsive disorder experience maternity care and mental health care during pregnancy and postpartum: A systematic literature review. J Affect Disord. 2022 Oct 1;314:1–18. Zappas MP, Becker K, Walton-Moss B. Postpartum Anxiety. J Nurse Pract. 2021 Jan 1;17(1):60–4. Dazzan P. A Step Closer to Understanding Familial Risk for Postpartum Psychosis. Am J Psychiatry. 2025 June;182(6):504–5. National Library of Medicine. Postpartum Depression Search [Internet]. 2025. Available from: https://pubmed.ncbi.nlm.nih.gov/?term=postpartum+depression National Library of Medicine. Postpartum Anxiety Search [Internet]. 2025. Available from: https://pubmed.ncbi.nlm.nih.gov/?term=postpartum+anxiety National Library of Medicine. Postpartum OCD Search [Internet]. 2025. Available from: https://pubmed.ncbi.nlm.nih.gov/?term=postpartum+obsessive+compulsive+disorder Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterial10.20.25.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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10:54:50","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":59752,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrevalence rates of symptoms of all disorders and depression\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-7907843/v1/25ba066bcbbb090e9d88fa68.png"},{"id":98774609,"identity":"1d17545c-0b97-41b7-8f98-fa039d7ac718","added_by":"auto","created_at":"2025-12-22 12:04:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1850192,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7907843/v1/5c2899f0-4909-4a3c-bc27-fff596dee2bb.pdf"},{"id":95823243,"identity":"a8fdab26-880a-476b-9bdb-9709d13fd165","added_by":"auto","created_at":"2025-11-13 10:54:50","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":75987,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial10.20.25.docx","url":"https://assets-eu.researchsquare.com/files/rs-7907843/v1/73b89862a95d1773613d27ea.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessing the Prevalence of Maternal Mental Health Disorders Between Six Weeks and Six Months Postpartum—A Scoping Review","fulltext":[{"header":"Background","content":"\u003cp\u003eMental health is a critical aspect of pregnancy and the first three years postpartum (\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Within the field of perinatal mental health, psychological disorders predominate the literature given their prevalence and severity (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Such disorders, called perinatal mood and anxiety disorders (PMADs), include perinatal depression, anxiety, psychosis, bipolar disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD) (\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). These disorders are primary causes of morbidity and mortality among pregnant and postpartum people worldwide (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe literature reports that perinatal depression and anxiety are the most commonly experienced PMADs (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Global estimates indicate that up to one-in-six perinatal people experience perinatal depression and/or anxiety (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In the postpartum period, the prevalence of bipolar disorder has been reported at 3.3% to 25.5%, OCD at 2% to 24%, PTSD at 0% to 43%, and psychosis at 0.089% to 0.5% (\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Some of these rates exclude people with existing symptoms, despite the risks postpartum people with pre-existing mental health conditions face for continued or exacerbated symptoms (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). For example, review of the literature indicates that up to 70% of women with preexisting OCD experience a worsening of symptoms in the perinatal period (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAdverse mental health outcomes associated with perinatal depression and other PMADs may persist for up to three years postpartum, driven by a complex interplay of contextual, intersecting, and multi-level factors (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). These include biological, psychological, and social variables, including hormonal and genetic factors, stress, and experiences of social support and/or violence (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). For example, estrogen and progesterone levels drop significantly in the first few days postpartum\u0026mdash;a hypothesized contributor to the subsyndromal condition, postpartum blues (\u003cspan additionalcitationids=\"CR23 CR24 CR25 CR26\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The hormones then fluctuate but typically normalize by the last postpartum visit at six-to-eight weeks postpartum, though hormone trajectories are influenced by factors such as age and breastfeeding status (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan additionalcitationids=\"CR25 CR26 CR27 CR28\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Such hormonal shifts have been implicated in one\u0026rsquo;s risk for developing postpartum depression (PPD) (\u003cspan additionalcitationids=\"CR23 CR24 CR25\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). While some risk factors may have more influence on mental health in the first six weeks postpartum\u0026mdash;when the onset of PPD is classified\u0026mdash;other factors, e.g., lack of social support, continue and/or are exacerbated beyond the sixth week after giving birth (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31 CR32 CR33 CR34\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Despite the continuance of these risk factors, there is a comparative lack of research on such mental health topics beyond six to 12 weeks postpartum (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn addition to common risk factors, individual experiences of PMADs vary significantly by geographic region and country income level (\u003cspan additionalcitationids=\"CR39 CR40 CR41\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). For example, studies show that some populations in sub-Saharan Africa may describe symptoms of depression, including perinatal depression, more somatically or through \u0026ldquo;thinking too much\u0026rdquo; rather than a new lack of interest in doing things (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Additionally, despite the global prevalence and diversity of PMADs, there is a lack of literature about them from low- and middle-income countries (LMICs) compared to high-income countries (HICs) (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). This is concerning, as reported rates of PPD have been lower in HICs compared to LMICs (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCommonly utilized instruments to measure PMAD symptoms, specifically those of PPD and postpartum anxiety, include the 10-item Edinburgh Postnatal Depression Scale (EPDS), the nine-item Patient Health Questionnaire (PHQ-9), and the seven-item Generalized Anxiety Disorder Scale (GAD-7) (\u003cspan additionalcitationids=\"CR47\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). These and other screening tools use one or more cut-off scores to delineate between levels of symptom severity and/or presence/absence of (probable) mental health disorders, depending on the researcher\u0026rsquo;s interpretation of their results (\u003cspan additionalcitationids=\"CR50 CR51\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e). While the gold standard for mental health disorder assessments is diagnosis by a qualified medical professional, access to such professionals may not be possible in all regions and research studies (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). Another consideration is that although mental health screening tools are useful, they have also been critiqued for their lack of cross-cultural relevance in capturing people\u0026rsquo;s symptoms (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan additionalcitationids=\"CR56\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIt is evident that PPD and additional PMADs are of critical importance in the postpartum period but under-researched (i) beyond six weeks postpartum and (ii) in LMICs. Therefore, the aim of this review was to document the global prevalence of PPD and related PMAD symptoms from six weeks to six months postpartum.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis scoping review was conducted in accordance with the \u003cem\u003ePreferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews\u003c/em\u003e (PRISMA-ScR) guidelines, ensuring adherence to best practices for systematically identifying, selecting, and mapping relevant evidence (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eEligibility Criteria, Information Sources, and Search\u003c/h2\u003e\u003cp\u003eEligible sources included peer-reviewed, indexed, primary research articles published between 2019 and 2024 in English. A clinically-oriented search strategy was developed in collaboration with a medical librarian at the University of California San Francisco (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The initial search string was designed for PubMed and subsequently adapted for Embase and CINAHL (Supplementary Material 1). Searches incorporated both \u0026lsquo;All Fields\u0026rsquo; terms and controlled vocabularies (MeSH and Emtree) to maximize sensitivity and capture the breadth of relevant literature. The database searches were conducted on July 23, 2024. Following full-text screening, reference lists of relevant review articles populated through the search strategy were examined using snowball sampling. Articles identified from reference lists via snowball sampling were subjected to the same eligibility screening and review process as the original dataset.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePubMed Search String\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSearch term\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVariations of search terms\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eField\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePostpartum depression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e((\"depression, postpartum\") OR ((\"postpartum\" OR \"postnatal\" OR \"post-partum\" OR \"post-natal\") AND depress*))\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMeSH; Title/abstract\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence/\u003c/p\u003e\u003cp\u003eprevalence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e(\"incidence\" OR \"prevalence\" OR diagnosis* OR treat* OR screen*)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTitle/abstract\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClinical inquiry\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e((Therapy/Broad[filter]) OR (Diagnosis/Broad[narrow]))\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFilter\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eArticle criteria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eEnglish\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003ePast 5 years (2019\u0026ndash;2024)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFilter\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSelection of Sources of Evidence\u003c/h3\u003e\n\u003cp\u003eCitations from all databases were exported into Covidence, an online platform for managing systematic reviews (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e). Following deduplication, the title/abstract screening of the articles were completed by two independent reviewers, with a third resolving conflicts, such as around inclusion/exclusion criteria. Reviewers relied on an a-priori set of inclusion and exclusion criteria (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) to identify quantitative research studies with an incidence and/or prevalence measure of mental health diagnoses among postpartum persons between six-weeks and six-months postpartum (inclusive). The same screening process\u0026mdash;two independent reviewers with a third resolving conflicts\u0026mdash; and criteria were used for the full-text review.\u003c/p\u003e\u003cp\u003eBoth incidence and prevalence were included in this scoping review because the terms have been used interchangeably in the literature (\u003cspan additionalcitationids=\"CR62 CR63 CR64 CR65 CR66 CR67\" citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e). Therefore, \u0026ldquo;prevalence\u0026rdquo; is referred to throughout this paper as inclusive of both measures: the focus of this study was not to differentiate between these two rates but to understand the overall rate of PPD and related PMADs. Additionally, the reviewers excluded studies that included only samples of people estimated or known to have higher rates of mental health disorders. Including such studies, such as those including only postpartum people with histories of mental health disorders, could inflate the overall prevalence rate reported in the results. When studies included populations hypothesized to have higher rates of mental health disorders alongside a control group, data from the latter were included in this study. Such studies may not have had a primary focus on PMADs but still measured and reported on them.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eInclusion and Exclusion Criteria\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInclusion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExclusion\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePopulation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePostpartum people who are between six weeks and six months postpartum (inclusive)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEntire sample hypothesized to have higher rates of postpartum mental health disorders (e.g., all had previously diagnosed mental health disorders)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort, cross-sectional, case-control studies, intervention studies with control group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntervention studies with no control group, protocols, qualitative studies, case studies, reviews, commentaries\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutcome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence and/or prevalence for postpartum mental health diagnoses or symptoms measured with a validated tool between six weeks to six months postpartum (inclusive)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMeasurement of only mental health symptom severity (not prevalence/incidence)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePublication Characteristics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFull-text in English available\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo full-text in English available\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eData Collection and Extraction\u003c/h3\u003e\n\u003cp\u003eAfter full-text screening, one reviewer independently extracted data from the included articles in Covidence into a Microsoft Excel sheet (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e). The reviewer extracted data for 15 key variables (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) from each included article, including publication year, study design, screening tools implemented, and prevalence/incidence rates among others. Country income and world region were determined by the 2025 fiscal year World Bank country classifications (\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eExtraction Variables\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Author(s), year\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6. Study aim\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11. Postpartum periods measured\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. Title\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7. Study design\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12. Mental health disorders examined\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8. Inclusion criteria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13. Screening/diagnosis tools used\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Country and country income level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9. Exclusion criteria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14. Screening/diagnosis tool cut-off scores\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. World region\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10. Sample characteristics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15. Prevalence/incidence rates\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSeveral factors were considered when extracting data for this review. First, when multiple cut-off scores were used, data for all cut-off scores considered beyond \u0026ldquo;borderline\u0026rdquo; symptoms/disorders were extracted. When in doubt of the cut-off scores used, the researchers contacted the study authors (eight authors emailed). Second, in cases in which the entire sample was disaggregated by postpartum interval (e.g., 0\u0026ndash;3 months, 3\u0026ndash;6 months, etc.) only data for subgroups within the six weeks to six months were extracted. Third, unweighted or weighted results were reported based on the provided data. The unweighted data were extracted for one study that used inverse probability weighting to adjust for attrition bias, which aligned with the aim to represent overall findings, not more advanced analyses relevant for a meta-analysis (\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e). Fourth, aligning with many scoping review designs, study quality was not systematically assessed (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eSynthesis of Results\u003c/h3\u003e\n\u003cp\u003eData cleaning included categorizing the postpartum periods measured (when and how often), consolidating inclusion/exclusion criteria, and standardizing the cut-off score reporting in a new variable. While screening and diagnosis tools and their respective cut-off scores were extracted as reported, some studies deviated in the way they reported their cut-off scores\u0026mdash;a finding highlighted in the results. Descriptive statistics were used to summarize the data: the number of studies, their countries, regions, country income levels, study designs, study topics (based on study aim), and number of total samples. Each individual measurement of postpartum mental health symptoms counted as a sample. For example, a study that measured postpartum anxiety symptoms at two different time periods (e.g., at two and three months) would have two samples. Similarly, a study that measured one time period but reported prevalence rates based on two different cut-off scores (e.g., 10 and 12 on the EPDS) would also have two samples.\u003c/p\u003e\u003cp\u003eOnce data cleaning was completed, the data were exported to StataBE for analysis (\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e). Using the total samples (i.e, number of measurements), the minimum, maximum, median, and interquartile range (IQR) were calculated for the positive prevalence rate of symptoms for all disorders and for PPD specifically. The EPDS cut-off scores used to measure PPD symptoms were also descriptively summarized.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 1,606 unique studies were captured and screened during the initial title/abstract review (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Two-hundred-twenty-eight publications met inclusion/exclusion criteria and were reviewed in full-text, among which 148 were excluded. The most common reason for exclusion was that studies did not meet the population inclusion criteria (n\u0026thinsp;=\u0026thinsp;119, 80.41%), including studies without data specific to people six weeks to six months postpartum (n\u0026thinsp;=\u0026thinsp;78, 52.70%). A total of 80 studies met all criteria and were included in this study (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR50\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan additionalcitationids=\"CR65 CR66 CR67\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan additionalcitationids=\"CR76 CR77 CR78 CR79 CR80 CR81 CR82 CR83 CR84 CR85 CR86 CR87 CR88 CR89 CR90 CR91 CR92 CR93 CR94 CR95 CR96 CR97 CR98 CR99 CR100 CR101 CR102 CR103 CR104 CR105 CR106 CR107 CR108 CR109 CR110 CR111 CR112 CR113 CR114 CR115 CR116 CR117 CR118 CR119 CR120 CR121 CR122 CR123 CR124 CR125 CR126 CR127 CR128 CR129 CR130 CR131 CR132 CR133 CR134 CR135 CR136 CR137 CR138 CR139 CR140 CR141\" citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR142\" class=\"CitationRef\"\u003e142\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStudy characteristics\u003c/h2\u003e\u003cp\u003eThe 80 included studies (Supplementary Material 2) were conducted across 40 unique countries (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR50\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan additionalcitationids=\"CR65 CR66 CR67\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan additionalcitationids=\"CR76 CR77 CR78 CR79 CR80 CR81 CR82 CR83 CR84 CR85 CR86 CR87 CR88 CR89 CR90 CR91 CR92 CR93 CR94 CR95 CR96 CR97 CR98 CR99 CR100 CR101 CR102 CR103 CR104 CR105 CR106 CR107 CR108 CR109 CR110 CR111 CR112 CR113 CR114 CR115 CR116 CR117 CR118 CR119 CR120 CR121 CR122 CR123 CR124 CR125 CR126 CR127 CR128 CR129 CR130 CR131 CR132 CR133 CR134 CR135 CR136 CR137 CR138 CR139 CR140 CR141\" citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR142\" class=\"CitationRef\"\u003e142\u003c/span\u003e). Based on World Bank definitions, the studies were most frequently located in East Asia and the Pacific (n\u0026thinsp;=\u0026thinsp;28; 35.00%), followed by Europe and Central Asia (n\u0026thinsp;=\u0026thinsp;20; 25.00%), sub-Saharan Africa (n\u0026thinsp;=\u0026thinsp;10; 12.50%), North America (n\u0026thinsp;=\u0026thinsp;8; 10.00%), Middle East and North Africa (n\u0026thinsp;=\u0026thinsp;7; 8.75%), South Asia (n\u0026thinsp;=\u0026thinsp;5; 6.25%), and Latin America and the Caribbean (n\u0026thinsp;=\u0026thinsp;2; 2.50%) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR50\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan additionalcitationids=\"CR65 CR66 CR67\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan additionalcitationids=\"CR76 CR77 CR78 CR79 CR80 CR81 CR82 CR83 CR84 CR85 CR86 CR87 CR88 CR89 CR90 CR91 CR92 CR93 CR94 CR95 CR96 CR97 CR98 CR99 CR100 CR101 CR102 CR103 CR104 CR105 CR106 CR107 CR108 CR109 CR110 CR111 CR112 CR113 CR114 CR115 CR116 CR117 CR118 CR119 CR120 CR121 CR122 CR123 CR124 CR125 CR126 CR127 CR128 CR129 CR130 CR131 CR132 CR133 CR134 CR135 CR136 CR137 CR138 CR139 CR140 CR141\" citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR142\" class=\"CitationRef\"\u003e142\u003c/span\u003e). A plurality came from China with 16 studies (20.00%), then six (7.50%) from the United States (U.S.), and four (5.00%) from India, followed by Ethiopia, France, Iran, Italy, and Norway (n\u0026thinsp;=\u0026thinsp;3; 3.75% each) (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan additionalcitationids=\"CR65 CR66 CR67\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e, \u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e, \u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e, \u003cspan additionalcitationids=\"CR110\" citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e, \u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e113\u003c/span\u003e, \u003cspan citationid=\"CR115\" class=\"CitationRef\"\u003e115\u003c/span\u003e, \u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e118\u003c/span\u003e, \u003cspan additionalcitationids=\"CR121 CR122 CR123\" citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR124\" class=\"CitationRef\"\u003e124\u003c/span\u003e, \u003cspan additionalcitationids=\"CR127 CR128\" citationid=\"CR126\" class=\"CitationRef\"\u003e126\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR129\" class=\"CitationRef\"\u003e129\u003c/span\u003e, \u003cspan citationid=\"CR131\" class=\"CitationRef\"\u003e131\u003c/span\u003e, \u003cspan citationid=\"CR134\" class=\"CitationRef\"\u003e134\u003c/span\u003e, \u003cspan additionalcitationids=\"CR137 CR138 CR139 CR140\" citationid=\"CR136\" class=\"CitationRef\"\u003e136\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR141\" class=\"CitationRef\"\u003e141\u003c/span\u003e). Thirty-four (42.50%) of studies came from HICs, 28 (35.00%) from upper middle-income countries (MICs), 12 (15.00%) from lower MICs, and 6 (7.50%) from low-income countries (LICs) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR50\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan additionalcitationids=\"CR65 CR66 CR67\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan additionalcitationids=\"CR76 CR77 CR78 CR79 CR80 CR81 CR82 CR83 CR84 CR85 CR86 CR87 CR88 CR89 CR90 CR91 CR92 CR93 CR94 CR95 CR96 CR97 CR98 CR99 CR100 CR101 CR102 CR103 CR104 CR105 CR106 CR107 CR108 CR109 CR110 CR111 CR112 CR113 CR114 CR115 CR116 CR117 CR118 CR119 CR120 CR121 CR122 CR123 CR124 CR125 CR126 CR127 CR128 CR129 CR130 CR131 CR132 CR133 CR134 CR135 CR136 CR137 CR138 CR139 CR140 CR141\" citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR142\" class=\"CitationRef\"\u003e142\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe studies differed in their sample sizes and postpartum participant characteristics. The range of studies\u0026rsquo; total sample sizes ranged from 50 to 90,194 with a median of 430 people (\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e, \u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e, \u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e112\u003c/span\u003e, \u003cspan citationid=\"CR116\" class=\"CitationRef\"\u003e116\u003c/span\u003e). Study participants\u0026rsquo; ages ranged from 12 to 53, with a median average study age of 30 (\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR132\" class=\"CitationRef\"\u003e132\u003c/span\u003e). Participants in most studies were married and/or living with a partner, with a median reported study value of 95.31% (range of 7.22% to 100.00%) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e, \u003cspan citationid=\"CR116\" class=\"CitationRef\"\u003e116\u003c/span\u003e, \u003cspan citationid=\"CR142\" class=\"CitationRef\"\u003e142\u003c/span\u003e). Studies ranged from only including primiparous participants to only multiparous ones, with the median percentage of multiparous participants of 52.85% (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e, \u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e, \u003cspan citationid=\"CR117\" class=\"CitationRef\"\u003e117\u003c/span\u003e, \u003cspan citationid=\"CR131\" class=\"CitationRef\"\u003e131\u003c/span\u003e, \u003cspan citationid=\"CR134\" class=\"CitationRef\"\u003e134\u003c/span\u003e, \u003cspan citationid=\"CR137\" class=\"CitationRef\"\u003e137\u003c/span\u003e). The range of participants in each study who had completed at least high school ranged from 9.20% to 100.00%, with a median reported value among studies of 82.35% (\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e, \u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e, \u003cspan citationid=\"CR130\" class=\"CitationRef\"\u003e130\u003c/span\u003e). Participant employment among studies also differed, but the majority of participants were unemployed and/or homemakers, ranging from 5.00\u0026ndash;94.00% with a median value of 39.00% (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e112\u003c/span\u003e, \u003cspan citationid=\"CR128\" class=\"CitationRef\"\u003e128\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eApproximately half of the studies utilized a cohort design (n\u0026thinsp;=\u0026thinsp;41; 51.25%), followed by cross-sectional (n\u0026thinsp;=\u0026thinsp;24; 30.00%), experimental (n\u0026thinsp;=\u0026thinsp;13; 16.25%), case-control (n\u0026thinsp;=\u0026thinsp;1; 1.25%), and instrument validation (n\u0026thinsp;=\u0026thinsp;1; 1.25%) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR50\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan additionalcitationids=\"CR65 CR66 CR67\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan additionalcitationids=\"CR76 CR77 CR78 CR79 CR80 CR81 CR82 CR83 CR84 CR85 CR86 CR87 CR88 CR89 CR90 CR91 CR92 CR93 CR94 CR95 CR96 CR97 CR98 CR99 CR100 CR101 CR102 CR103 CR104 CR105 CR106 CR107 CR108 CR109 CR110 CR111 CR112 CR113 CR114 CR115 CR116 CR117 CR118 CR119 CR120 CR121 CR122 CR123 CR124 CR125 CR126 CR127 CR128 CR129 CR130 CR131 CR132 CR133 CR134 CR135 CR136 CR137 CR138 CR139 CR140 CR141\" citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR142\" class=\"CitationRef\"\u003e142\u003c/span\u003e). Over half of studies (n\u0026thinsp;=\u0026thinsp;47, 58.75%) examined the association between one or more specific risk factor(s) and PMAD symptoms, followed by 23.75% (n\u0026thinsp;=\u0026thinsp;19) that explored symptom prevalence and overall risk factors (\u003cspan additionalcitationids=\"CR50\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan additionalcitationids=\"CR76 CR77 CR78 CR79 CR80\" citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan additionalcitationids=\"CR87 CR88 CR89 CR90\" citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e, \u003cspan additionalcitationids=\"CR97 CR98 CR99 CR100 CR101 CR102 CR103 CR104 CR105 CR106 CR107 CR108 CR109 CR110\" citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e, \u003cspan additionalcitationids=\"CR114 CR115 CR116 CR117 CR118 CR119\" citationid=\"CR113\" class=\"CitationRef\"\u003e113\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e, \u003cspan citationid=\"CR123\" class=\"CitationRef\"\u003e123\u003c/span\u003e, \u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e, \u003cspan additionalcitationids=\"CR128\" citationid=\"CR127\" class=\"CitationRef\"\u003e127\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR129\" class=\"CitationRef\"\u003e129\u003c/span\u003e, \u003cspan additionalcitationids=\"CR132 CR133 CR134\" citationid=\"CR131\" class=\"CitationRef\"\u003e131\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR135\" class=\"CitationRef\"\u003e135\u003c/span\u003e, \u003cspan additionalcitationids=\"CR138 CR139\" citationid=\"CR137\" class=\"CitationRef\"\u003e137\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR140\" class=\"CitationRef\"\u003e140\u003c/span\u003e, \u003cspan citationid=\"CR142\" class=\"CitationRef\"\u003e142\u003c/span\u003e). Three studies (3.75%) examined types and/or trajectories of symptoms, one study (1.25%) validated a screening tool, and 10 studies (12.50%) explored more than one category above (e.g., both symptom trajectories and their association with one specific risk factor) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e112\u003c/span\u003e, \u003cspan citationid=\"CR121\" class=\"CitationRef\"\u003e121\u003c/span\u003e, \u003cspan citationid=\"CR122\" class=\"CitationRef\"\u003e122\u003c/span\u003e, \u003cspan citationid=\"CR124\" class=\"CitationRef\"\u003e124\u003c/span\u003e, \u003cspan citationid=\"CR130\" class=\"CitationRef\"\u003e130\u003c/span\u003e, \u003cspan citationid=\"CR136\" class=\"CitationRef\"\u003e136\u003c/span\u003e, \u003cspan citationid=\"CR141\" class=\"CitationRef\"\u003e141\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlmost half of studies excluded potential participants with a personal or family history of mental health disorders (n\u0026thinsp;=\u0026thinsp;37; 46.25%) (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan additionalcitationids=\"CR65\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan additionalcitationids=\"CR85\" citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e, \u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e, \u003cspan additionalcitationids=\"CR106 CR107 CR108 CR109\" citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e, \u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e113\u003c/span\u003e, \u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e, \u003cspan citationid=\"CR117\" class=\"CitationRef\"\u003e117\u003c/span\u003e, \u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e119\u003c/span\u003e, \u003cspan additionalcitationids=\"CR123\" citationid=\"CR122\" class=\"CitationRef\"\u003e122\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR124\" class=\"CitationRef\"\u003e124\u003c/span\u003e, \u003cspan citationid=\"CR134\" class=\"CitationRef\"\u003e134\u003c/span\u003e, \u003cspan additionalcitationids=\"CR138 CR139 CR140 CR141\" citationid=\"CR137\" class=\"CitationRef\"\u003e137\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR142\" class=\"CitationRef\"\u003e142\u003c/span\u003e). However, there were also data from four observational studies including people with somatic diagnoses (5.00%; e.g., patients who were normotensive versus those who had preeclampsia) among the included articles (\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e113\u003c/span\u003e, \u003cspan citationid=\"CR115\" class=\"CitationRef\"\u003e115\u003c/span\u003e, \u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e). In such cases, these studies were exploratory rather than based on prior assumptions of the sample population(s) having higher rates of PMAD symptoms than the general population (\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e113\u003c/span\u003e, \u003cspan citationid=\"CR115\" class=\"CitationRef\"\u003e115\u003c/span\u003e, \u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe vast majority of studies (n\u0026thinsp;=\u0026thinsp;78, 97.50%) measured depressive symptoms, using screening tools such as the EPDS (n\u0026thinsp;=\u0026thinsp;65, 83.33%), PHQ-9 (n\u0026thinsp;=\u0026thinsp;4; 5.13%), clinical interviews (n\u0026thinsp;=\u0026thinsp;3; 3.85%), Center for Epidemiologic Studies Depression Scale (CES-D) (n\u0026thinsp;=\u0026thinsp;2; 2.56%), Quick Inventory of Depressive Symptomatology (QIDS) (n\u0026thinsp;=\u0026thinsp;1; 1.28%), or more than one of the above (n\u0026thinsp;=\u0026thinsp;3; 3.85; Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) (\u003cspan additionalcitationids=\"CR50\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan additionalcitationids=\"CR65 CR66 CR67\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan additionalcitationids=\"CR76 CR77 CR78 CR79 CR80 CR81 CR82 CR83 CR84 CR85 CR86 CR87 CR88 CR89 CR90 CR91 CR92 CR93 CR94 CR95 CR96 CR97 CR98 CR99 CR100 CR101 CR102 CR103 CR104 CR105 CR106 CR107 CR108 CR109 CR110 CR111 CR112 CR113 CR114 CR115 CR116 CR117 CR118 CR119\" citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e, \u003cspan additionalcitationids=\"CR123 CR124 CR125 CR126 CR127 CR128 CR129 CR130 CR131 CR132 CR133 CR134 CR135 CR136 CR137 CR138 CR139 CR140 CR141\" citationid=\"CR122\" class=\"CitationRef\"\u003e122\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR142\" class=\"CitationRef\"\u003e142\u003c/span\u003e). Seventy-three of the studies (91.25%) measured symptoms of PPD alone (\u003cspan additionalcitationids=\"CR50\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan additionalcitationids=\"CR65 CR66 CR67\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan additionalcitationids=\"CR76 CR77 CR78 CR79 CR80 CR81 CR82 CR83\" citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan additionalcitationids=\"CR87 CR88 CR89 CR90 CR91 CR92 CR93 CR94\" citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e, \u003cspan additionalcitationids=\"CR100 CR101 CR102 CR103 CR104 CR105 CR106 CR107 CR108 CR109 CR110 CR111 CR112 CR113 CR114 CR115 CR116 CR117\" citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e118\u003c/span\u003e, \u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e, \u003cspan additionalcitationids=\"CR123\" citationid=\"CR122\" class=\"CitationRef\"\u003e122\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR124\" class=\"CitationRef\"\u003e124\u003c/span\u003e, \u003cspan additionalcitationids=\"CR127 CR128 CR129 CR130 CR131 CR132 CR133 CR134 CR135 CR136 CR137 CR138 CR139 CR140 CR141\" citationid=\"CR126\" class=\"CitationRef\"\u003e126\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR142\" class=\"CitationRef\"\u003e142\u003c/span\u003e). Five studies (6.25%) measured symptoms of depression and other mental health disorders, including anxiety (n\u0026thinsp;=\u0026thinsp;2, 2.50%), PTSD (n\u0026thinsp;=\u0026thinsp;1, 1.25%), both anxiety and PTSD (n\u0026thinsp;=\u0026thinsp;1, 1.25%), and postpartum adjustment disorder (n\u0026thinsp;=\u0026thinsp;1, 1.25%) (\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e98\u003c/span\u003e, \u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e119\u003c/span\u003e, \u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e). Two studies (2.50%) measured OCD symptoms only (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR121\" class=\"CitationRef\"\u003e121\u003c/span\u003e). Studies used the anxiety subscale of the 90-item Symptom Checklist (SCL-90), EPDS-3A, and GAD-7 (n\u0026thinsp;=\u0026thinsp;1, 33.33% each) to measure anxiety symptoms (\u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e98\u003c/span\u003e, \u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e119\u003c/span\u003e, \u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e). The 16-item Harvard Trauma Questionnaire (HTQ-16) and Posttraumatic Diagnostic Scale (PDS/PDS-5) (n\u0026thinsp;=\u0026thinsp;1, 50.00% each) were used to measure PTSD (\u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e). Clinical interviews were used to capture OCD symptoms (n\u0026thinsp;=\u0026thinsp;2, 100.00%) and adjustment disorder symptoms (n\u0026thinsp;=\u0026thinsp;1; 100%; Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR121\" class=\"CitationRef\"\u003e121\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eStudies differed in when and how often they measured postpartum mental health symptoms. The majority of studies (N\u0026thinsp;=\u0026thinsp;63, 78.75%) included samples from only one postpartum interval, mostly within the six-to-eight week time period (n\u0026thinsp;=\u0026thinsp;43, 53.75%; Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) (\u003cspan additionalcitationids=\"CR50\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan additionalcitationids=\"CR65 CR66 CR67\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan additionalcitationids=\"CR76 CR77 CR78 CR79 CR80 CR81 CR82 CR83 CR84\" citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan additionalcitationids=\"CR88 CR89 CR90 CR91\" citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e, \u003cspan additionalcitationids=\"CR100 CR101 CR102 CR103 CR104 CR105 CR106\" citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e, \u003cspan additionalcitationids=\"CR112\" citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e113\u003c/span\u003e, \u003cspan citationid=\"CR115\" class=\"CitationRef\"\u003e115\u003c/span\u003e, \u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e118\u003c/span\u003e, \u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e119\u003c/span\u003e, \u003cspan additionalcitationids=\"CR122 CR123 CR124\" citationid=\"CR121\" class=\"CitationRef\"\u003e121\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e, \u003cspan additionalcitationids=\"CR128\" citationid=\"CR127\" class=\"CitationRef\"\u003e127\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR129\" class=\"CitationRef\"\u003e129\u003c/span\u003e, \u003cspan additionalcitationids=\"CR132 CR133 CR134\" citationid=\"CR131\" class=\"CitationRef\"\u003e131\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR135\" class=\"CitationRef\"\u003e135\u003c/span\u003e, \u003cspan additionalcitationids=\"CR138 CR139 CR140 CR141\" citationid=\"CR137\" class=\"CitationRef\"\u003e137\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR142\" class=\"CitationRef\"\u003e142\u003c/span\u003e). Others measured the same or different samples from two (n\u0026thinsp;=\u0026thinsp;14, 17.50%), or three or more postpartum intervals (n\u0026thinsp;=\u0026thinsp;3, 3.75%) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan additionalcitationids=\"CR94 CR95\" citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e98\u003c/span\u003e, \u003cspan additionalcitationids=\"CR109\" citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e, \u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e, \u003cspan citationid=\"CR116\" class=\"CitationRef\"\u003e116\u003c/span\u003e, \u003cspan citationid=\"CR117\" class=\"CitationRef\"\u003e117\u003c/span\u003e, \u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e, \u003cspan citationid=\"CR126\" class=\"CitationRef\"\u003e126\u003c/span\u003e, \u003cspan citationid=\"CR130\" class=\"CitationRef\"\u003e130\u003c/span\u003e, \u003cspan citationid=\"CR136\" class=\"CitationRef\"\u003e136\u003c/span\u003e). Among the studies that measured their samples in multiple time intervals, almost half (n\u0026thinsp;=\u0026thinsp;8, 10.00% of total studies) included a six-to-eight week measurement, and a little over half did not (n\u0026thinsp;=\u0026thinsp;9, 11.25% of total studies) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan additionalcitationids=\"CR94 CR95\" citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e98\u003c/span\u003e, \u003cspan additionalcitationids=\"CR109\" citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e, \u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e, \u003cspan citationid=\"CR116\" class=\"CitationRef\"\u003e116\u003c/span\u003e, \u003cspan citationid=\"CR117\" class=\"CitationRef\"\u003e117\u003c/span\u003e, \u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e, \u003cspan citationid=\"CR126\" class=\"CitationRef\"\u003e126\u003c/span\u003e, \u003cspan citationid=\"CR130\" class=\"CitationRef\"\u003e130\u003c/span\u003e, \u003cspan citationid=\"CR136\" class=\"CitationRef\"\u003e136\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAcross the included studies, there were 145 postpartum samples\u0026mdash;due to some studies (i) reporting prevalence rates disaggregated by subgroups only rather than the entire sample (n\u0026thinsp;=\u0026thinsp;12, 15.00%), (ii) measuring the same or different samples at multiple time periods (n\u0026thinsp;=\u0026thinsp;17, 21.25%), and/or (iii) reporting more than one rate using multiple cut-off scores and/or instruments for the same or different disorders (n\u0026thinsp;=\u0026thinsp;11 ,13.75%) (\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e, \u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e112\u003c/span\u003e, \u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e, \u003cspan citationid=\"CR115\" class=\"CitationRef\"\u003e115\u003c/span\u003e, \u003cspan additionalcitationids=\"CR126\" citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR127\" class=\"CitationRef\"\u003e127\u003c/span\u003e, \u003cspan citationid=\"CR131\" class=\"CitationRef\"\u003e131\u003c/span\u003e, \u003cspan citationid=\"CR132\" class=\"CitationRef\"\u003e132\u003c/span\u003e, \u003cspan citationid=\"CR141\" class=\"CitationRef\"\u003e141\u003c/span\u003e). Among the total samples, 125 were for depression, 10 for OCD, five for anxiety, four for PTSD, and one for adjustment disorder. Thirty-eight (26.21%) of 145 samples were based on findings from control groups only. Eighty (55.17%) of the samples included total study participants, and the remaining 27 samples (18.62%) were subgroups of total samples or \u0026lsquo;intervention\u0026rsquo; groups in observational studies. The reported sample sizes of measurements ranged from 26 to 38,030, with a median of 266 (\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e112\u003c/span\u003e, \u003cspan citationid=\"CR115\" class=\"CitationRef\"\u003e115\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAcross samples, the prevalence rates of PMAD symptoms ranged from 0.00% (n\u0026thinsp;=\u0026thinsp;4) to 76.60% (n\u0026thinsp;=\u0026thinsp;1), with a median of 13.20% and an IQR of 12.20% (\u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e, \u003cspan citationid=\"CR116\" class=\"CitationRef\"\u003e116\u003c/span\u003e). Among the 125 samples assessed for depression, the prevalence rates of symptoms had the same range (0.00% (n\u0026thinsp;=\u0026thinsp;2) to 76.60% (n\u0026thinsp;=\u0026thinsp;1)), a median of 16.00%, and an IQR of 11.60% (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e) (\u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e, \u003cspan citationid=\"CR116\" class=\"CitationRef\"\u003e116\u003c/span\u003e, \u003cspan citationid=\"CR143\" class=\"CitationRef\"\u003e143\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe majority of samples assessed for depression were measured with the EPDS (n\u0026thinsp;=\u0026thinsp;101; 80.80%), followed by the PHQ-9 (n\u0026thinsp;=\u0026thinsp;12; 9.60%), clinical/diagnostic interviews (n\u0026thinsp;=\u0026thinsp;5; 4.00%), the QIDS (n\u0026thinsp;=\u0026thinsp;4; 3.20%), and the CES-D (n\u0026thinsp;=\u0026thinsp;3; 2.40%). Among samples measured with the EPDS alone, the median prevalence rate was 16.40% with an IQR of 10.50%. The minimum (0.00%) and maximum (76.60%) prevalence for samples of depressive symptoms were measured with the EPDS.\u003c/p\u003e\u003cp\u003eStudies (n\u0026thinsp;=\u0026thinsp;68) varied in how they reported and used EPDS cut-off scores (\u003cspan additionalcitationids=\"CR50\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan additionalcitationids=\"CR65 CR66 CR67\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan additionalcitationids=\"CR76 CR77 CR78 CR79 CR80 CR81 CR82 CR83\" citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan additionalcitationids=\"CR89 CR90 CR91 CR92 CR93 CR94\" citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan additionalcitationids=\"CR98 CR99 CR100 CR101 CR102\" citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e, \u003cspan additionalcitationids=\"CR106 CR107 CR108 CR109 CR110 CR111 CR112 CR113\" citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e, \u003cspan additionalcitationids=\"CR117 CR118\" citationid=\"CR116\" class=\"CitationRef\"\u003e116\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e119\u003c/span\u003e, \u003cspan additionalcitationids=\"CR123 CR124\" citationid=\"CR122\" class=\"CitationRef\"\u003e122\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e, \u003cspan additionalcitationids=\"CR129 CR130 CR131 CR132 CR133\" citationid=\"CR128\" class=\"CitationRef\"\u003e128\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR134\" class=\"CitationRef\"\u003e134\u003c/span\u003e, \u003cspan additionalcitationids=\"CR139 CR140 CR141\" citationid=\"CR138\" class=\"CitationRef\"\u003e138\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR142\" class=\"CitationRef\"\u003e142\u003c/span\u003e). Studies reported the EPDS cut-off scores they used inclusively (i.e., x score or higher or \u0026sup3;x score; n\u0026thinsp;=\u0026thinsp;59, 86.76%), exclusively (i.e., greater than x score or \u0026gt;\u0026thinsp;x score; n\u0026thinsp;=\u0026thinsp;6, 8.82%), not explained (e.g., cut-off of x; n\u0026thinsp;=\u0026thinsp;1, 1.47%), or not at all (n\u0026thinsp;=\u0026thinsp;2, 2.94%). Sixteen (23.53%) studies reported the EPDS cut-off scores they used in multiple ways (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e, \u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e, \u003cspan additionalcitationids=\"CR110 CR111 CR112\" citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e113\u003c/span\u003e, \u003cspan citationid=\"CR122\" class=\"CitationRef\"\u003e122\u003c/span\u003e, \u003cspan citationid=\"CR134\" class=\"CitationRef\"\u003e134\u003c/span\u003e, \u003cspan citationid=\"CR141\" class=\"CitationRef\"\u003e141\u003c/span\u003e). These 16 studies reported EPDS cut-off scores in \u0026ldquo;\u0026sup3;x\u0026rdquo; and \u0026ldquo;(x-1)/x\u0026rdquo; formats or reporting an inclusive cut-off score but using the shorthand of \u0026ldquo;\u0026gt;x\u0026rdquo; (exclusive) rather than \u0026ldquo;\u0026sup3;x\u0026rdquo; (inclusive), the latter introducing inconsistencies (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e, \u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e, \u003cspan additionalcitationids=\"CR110 CR111 CR112\" citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e113\u003c/span\u003e, \u003cspan citationid=\"CR122\" class=\"CitationRef\"\u003e122\u003c/span\u003e, \u003cspan citationid=\"CR134\" class=\"CitationRef\"\u003e134\u003c/span\u003e, \u003cspan citationid=\"CR141\" class=\"CitationRef\"\u003e141\u003c/span\u003e). Additionally, one study considered a positive EPDS cut-off score as \u0026sup3;10 or thoughts of self-harm (\u003cspan citationid=\"CR116\" class=\"CitationRef\"\u003e116\u003c/span\u003e). After standardizing each cut-off score to be inclusive when possible (excluding the scores that were non-reported, not indicated as exclusive or inclusive, or combined with thoughts of self-harm), samples\u0026rsquo; EPDS cut-off scores (n\u0026thinsp;=\u0026thinsp;94) ranged from 9 to 14, with a median of 11 and an IQR of 3 (\u003cspan additionalcitationids=\"CR50\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan additionalcitationids=\"CR65 CR66\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan additionalcitationids=\"CR76 CR77 CR78 CR79 CR80 CR81 CR82 CR83\" citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan additionalcitationids=\"CR89 CR90 CR91 CR92 CR93 CR94\" citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan additionalcitationids=\"CR98 CR99 CR100 CR101 CR102\" citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e, \u003cspan additionalcitationids=\"CR106 CR107 CR108 CR109 CR110 CR111 CR112 CR113\" citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e, \u003cspan additionalcitationids=\"CR118\" citationid=\"CR117\" class=\"CitationRef\"\u003e117\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e119\u003c/span\u003e, \u003cspan additionalcitationids=\"CR123 CR124\" citationid=\"CR122\" class=\"CitationRef\"\u003e122\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e, \u003cspan additionalcitationids=\"CR129 CR130 CR131 CR132 CR133\" citationid=\"CR128\" class=\"CitationRef\"\u003e128\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR134\" class=\"CitationRef\"\u003e134\u003c/span\u003e, \u003cspan citationid=\"CR136\" class=\"CitationRef\"\u003e136\u003c/span\u003e, \u003cspan additionalcitationids=\"CR140 CR141\" citationid=\"CR139\" class=\"CitationRef\"\u003e139\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR142\" class=\"CitationRef\"\u003e142\u003c/span\u003e). The respective EPDS cut-off score ranges, medians, and IQRs varied by region, country income level, and postpartum measurement timeframe (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEPDS cut-off scores by region, country income level, and postpartum measurement timeframe\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategory (number of samples)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCut-off score range\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCut-off score median\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCut-off score IQR\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eWorld Region\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEast Asia and Pacific (n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u0026ndash;13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEurope and Central Asia (n\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLatin America and the Caribbean (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle East and North Africa (n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNorth America (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSouth Asia (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSub-Saharan Africa (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCountry Income Level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLIC (n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLower MIC (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUpper MIC (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u0026ndash;13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHIC (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u0026ndash;13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePostpartum Measurement Timeframe\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u0026ndash;8 weeks (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u0026ndash;14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9 weeks-3 months (exclusive) (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3 months (inclusive)-6 months (n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u0026ndash;13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u0026ndash;13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eLastly, given the small sample size for samples assessed for OCD, anxiety, PTSD, and adjustment disorder, amalgamated median and IQR were not calculated. The ranges of reported rates were 6.00\u0026ndash;9.00% for OCD, 3.00-16.70% for anxiety, and 0.00\u0026ndash;2.00% for PTSD (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e98\u003c/span\u003e, \u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e119\u003c/span\u003e, \u003cspan citationid=\"CR121\" class=\"CitationRef\"\u003e121\u003c/span\u003e, \u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e). The one sample assessed for adjustment disorder had a prevalence rate of 15.00% (\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe median prevalence rate of PMAD symptoms occurring between six weeks and six months postpartum (inclusive) was 13.20% (IQR\u0026thinsp;=\u0026thinsp;12.20%). The median prevalence rate for PPD symptoms during this timeframe was 16.00% (IQR\u0026thinsp;=\u0026thinsp;11.60%). The rate of PPD symptoms found in this study is similar to that found through a seminal meta-analysis on the disorder (17.22%) (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). However, the median prevalence rate for all PMAD symptoms was higher than that reported for meta-analyses examining postpartum anxiety disorders (8.50%), OCD (6.20%), and PTSD (3.10%) (\u003cspan additionalcitationids=\"CR145\" citationid=\"CR144\" class=\"CitationRef\"\u003e144\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR146\" class=\"CitationRef\"\u003e146\u003c/span\u003e). This discrepancy may be due to the overrepresentation of samples assessed for PPD symptoms (125 of 145 samples). The median prevalence rates of symptoms of anxiety, OCD, and PTSD identified in this review were closer to those rates. Overall, the median prevalence rates identified through this review indicate that PMAD, including PPD, symptoms continue beyond six weeks postpartum, necessitating interventions after individuals\u0026rsquo; last recommended postpartum visit (\u003cspan citationid=\"CR147\" class=\"CitationRef\"\u003e147\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOther important findings identified through this review were the unexpected range of PPD prevalence rates and unstandardized EPDS cut-off score reporting. The prevalence of PPD symptoms ranged from 0.00% to 76.60% (\u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e, \u003cspan citationid=\"CR116\" class=\"CitationRef\"\u003e116\u003c/span\u003e). Neither of these rates, all identified within control groups of 64\u0026ndash;119 participants, align with established literature on PPD (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR148\" class=\"CitationRef\"\u003e148\u003c/span\u003e). Based on these discrepancies, the methodological quality of some studies included in this review may need to be examined.\u003c/p\u003e\u003cp\u003eThis concern about study quality also applies to EPDS use in this study. The EPDS measures symptoms of anhedonia (lack of enjoyment and laughter), anxiety (blaming oneself, worry, panic, trouble coping), and depression (sleeping difficulties, sadness, crying, thoughts of self-harm) (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR149\" class=\"CitationRef\"\u003e149\u003c/span\u003e). The screening tool\u0026rsquo;s cut off scores often range from 10 to 13 (\u003cspan citationid=\"CR150\" class=\"CitationRef\"\u003e150\u003c/span\u003e). In this study, the range of inclusive EPDS cut-off scores ranged from 9 to 14, with a median cut-off score of 11. Cut-off scores differ based on the desired sensitivity/specificity of the tool, the severity of symptoms measured, and applicability to local cultural contexts (\u003cspan additionalcitationids=\"CR152\" citationid=\"CR151\" class=\"CitationRef\"\u003e151\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR153\" class=\"CitationRef\"\u003e153\u003c/span\u003e). While cut-off scores are useful for clinical practice and research studies, there are errors in using validated cut-off scores that are: (i) incorrectly interpreted, (ii) based on a different cultural group or gender, (iii) derived from frequently used cut-off scores (which over-represent English-speaking samples), and (iv) aggregated across various samples (\u003cspan citationid=\"CR154\" class=\"CitationRef\"\u003e154\u003c/span\u003e). In addition, this study identified the pitfalls of describing cut-off scores in different ways. Cut-off scores for the EPDS were reported inclusively, exclusively, not specified as inclusive or exclusive, not at all, or in multiple ways. This creates confusion and limits comparability across studies. Clear reporting of cut-off scores is needed for tangible clinical applications of PMADs research (\u003cspan citationid=\"CR151\" class=\"CitationRef\"\u003e151\u003c/span\u003e, \u003cspan citationid=\"CR152\" class=\"CitationRef\"\u003e152\u003c/span\u003e, \u003cspan citationid=\"CR154\" class=\"CitationRef\"\u003e154\u003c/span\u003e, \u003cspan citationid=\"CR155\" class=\"CitationRef\"\u003e155\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOther gaps identified through this scoping review were the lack of LIC representation, emphasis beyond six-to-eight weeks postpartum, and focus on understanding a broader baseline prevalence rate of PMADs. Only six studies from LICs were identified in this review, indicating a need for more research representing postpartum people\u0026rsquo;s experiences in these countries, aligning with prior research (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR156\" class=\"CitationRef\"\u003e156\u003c/span\u003e). For example, there are ongoing discussions in the literature about how the current use of PMAD screening instruments does not adequately capture people\u0026rsquo;s experiences and understandings of mental health in LICs and other LMICs (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR154\" class=\"CitationRef\"\u003e154\u003c/span\u003e). Moreover, over half of the studies only included samples from the six-to-eight week postpartum interval (\u003cspan additionalcitationids=\"CR50\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan additionalcitationids=\"CR65 CR66 CR67\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan additionalcitationids=\"CR83\" citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e, \u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e, \u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e, \u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e, \u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e, \u003cspan additionalcitationids=\"CR115\" citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR116\" class=\"CitationRef\"\u003e116\u003c/span\u003e, \u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e118\u003c/span\u003e, \u003cspan additionalcitationids=\"CR123\" citationid=\"CR122\" class=\"CitationRef\"\u003e122\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR124\" class=\"CitationRef\"\u003e124\u003c/span\u003e, \u003cspan additionalcitationids=\"CR127 CR128 CR129 CR130 CR131\" citationid=\"CR126\" class=\"CitationRef\"\u003e126\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR132\" class=\"CitationRef\"\u003e132\u003c/span\u003e, \u003cspan additionalcitationids=\"CR135 CR136 CR137 CR138 CR139\" citationid=\"CR134\" class=\"CitationRef\"\u003e134\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR140\" class=\"CitationRef\"\u003e140\u003c/span\u003e, \u003cspan citationid=\"CR142\" class=\"CitationRef\"\u003e142\u003c/span\u003e). This finding is concerning, as it continues to demonstrate that there is a comparative lack of research on PMADs beyond six to 12 weeks postpartum, even when a study is specifically looking for those later postpartum intervals (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Lastly, almost half of the samples analyzed in this review were based on control groups, intervention groups in observational studies, and subgroups. This means that almost half of studies were focusing on specific groups of people rather than trying to identify a broader baseline rate of PMAD symptoms, a baseline which is needed to understand the burden of PMADs in the general population (\u003cspan citationid=\"CR157\" class=\"CitationRef\"\u003e157\u003c/span\u003e, \u003cspan citationid=\"CR158\" class=\"CitationRef\"\u003e158\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhile this study provides valuable insights on the prevalence of PPD and related PMADs occurring from six weeks to six months postpartum, it is not without limitations. First, the search strategy and results mostly center on PPD, including no analyses of postpartum psychosis. The overrepresentation of PPD results occurred despite the snowball sampling of citations and the resulting inclusion of 78 articles included in this review. Unfortunately, this lack of focus on PMADs other than PPD is evident in the broader perinatal mental health literature as well (\u003cspan additionalcitationids=\"CR160\" citationid=\"CR159\" class=\"CitationRef\"\u003e159\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR161\" class=\"CitationRef\"\u003e161\u003c/span\u003e). For example, a simple PubMed search populated 15,428 results for \u0026ldquo;postpartum depression,\u0026rdquo; 5,546 for \u0026ldquo;postpartum anxiety,\u0026rdquo; and 222 for \u0026ldquo;postpartum obsessive-compulsive disorder\u0026rdquo; on September 9, 2025 (\u003cspan additionalcitationids=\"CR163\" citationid=\"CR162\" class=\"CitationRef\"\u003e162\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR164\" class=\"CitationRef\"\u003e164\u003c/span\u003e). Another limitation of this study is that the reported rates reflect symptoms of or risks for PMADs, based on the use of validated screening tools or diagnostic methods, rather than confirmed clinical diagnoses in all cases (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). However, only six of 145 samples analyzed in this review were measured using diagnostic clinical interviews. Therefore, many of the data would be missing if only strict clinical diagnoses were included (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). Despite these limitations, this is the first study to investigate the rate of PPD and related PMADs occurring from six weeks to six months postpartum\u0026mdash;research needed to inform clinical identification and treatment. Further, this study has highlighted gaps across PMAD measurements, including inconsistent reporting of screening tool cut-off scores used.\u003c/p\u003e\u003cp\u003eThis study\u0026rsquo;s findings are informative for researchers, clinicians, and policymakers to understand that PPD and related PMADs persist in the postpartum period beyond six weeks postpartum. Researchers may use these findings to inform further investigations of PMADs occurring after the immediate postpartum period, including the cross-cultural relevance of screening tools and cut-off scores. Both clinicians and policymakers can use the results of this scoping review to develop more targeted patient care practices and policies for patients who are six weeks to six months postpartum. Future systematic reviews and meta-analyses should be used to capture study quality and weighted prevalence and incidence rates. Future reviews should also examine and address risk factors associated with PMADs after six weeks postpartum. Qualitative studies are needed to understand postpartum people\u0026rsquo;s experiences and understandings of PMADs, particularly from LICs, for which the current quantitative research is scarce.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe results of this study indicate that PPD persists in the postpartum period beyond the last postpartum visit around six weeks postpartum. This study also identified the need for more comparable prevalence data: from LICs, focusing beyond six-to-eight weeks postpartum, and including disorders other than PPD. Importantly, the reporting of cut-off scores for PMAD screening instruments should be standardized in the literature to prevent confusion and facilitate comparability. Future systematic reviews and qualitative analyses are needed to explore PMAD prevalence rates with more rigor and culturally-informed perspectives.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCES-D- Center for Epidemiologic Studies Depression Scale\u003c/p\u003e\n\u003cp\u003eEPDS- Edinburgh Postnatal Depression Scale\u003c/p\u003e\n\u003cp\u003eGAD-7- Generalized Anxiety Disorder Scale\u003c/p\u003e\n\u003cp\u003eHIC- High-Income Country\u003c/p\u003e\n\u003cp\u003eHTQ-16- Harvard Trauma Questionnaire\u003c/p\u003e\n\u003cp\u003eIQR- Interquartile Range\u003c/p\u003e\n\u003cp\u003eLIC- Low-Income Country\u003c/p\u003e\n\u003cp\u003eLMICs- Low- and Middle-Income Countries\u003c/p\u003e\n\u003cp\u003eLower MIC- Lower Middle-Income Country\u003c/p\u003e\n\u003cp\u003eOCD- Obsessive-Compulsive Disorder\u003c/p\u003e\n\u003cp\u003ePDS/PDS-5- Posttraumatic Diagnostic Scale\u003c/p\u003e\n\u003cp\u003ePHQ-9- Patient Health Questionnaire\u003c/p\u003e\n\u003cp\u003ePMADs- Postpartum Mood and Anxiety Disorders\u003c/p\u003e\n\u003cp\u003ePPD- Postpartum Depression\u003c/p\u003e\n\u003cp\u003ePRISMA-ScR- Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews\u003c/p\u003e\n\u003cp\u003ePTSD- Post-Traumatic Stress Disorder\u003c/p\u003e\n\u003cp\u003eQIDS- Quick Inventory of Depressive Symptomatology\u003c/p\u003e\n\u003cp\u003eSCL-90- Symptom Checklist\u003c/p\u003e\n\u003cp\u003eUpper MIC- Upper Middle-Income Country\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eClinical trial number\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNo Institutional Review Board approval was needed for this study, as it was a review of the literature without any direct involvement of human participants.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used in the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis review was funded by the Leavitt Family Fund and the Wyss Medical Foundation. The funders had no roles in nor influence on the manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEB conducted the study\u0026rsquo;s search, title/abstract and full-text screening, data extraction, data analysis, and manuscript writing. AM, MRL, and SB were also reviewers during title/abstract screening. AM was the second reviewer for the full-text screening. PBG, KB, AB, and FFJ provided the conceptualization and general oversight for this review. AB served as the third full-text reviewer and provided direct oversight and guidance for EB. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge Miranda Rouse for the support she provided for this review.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFitzgerald L, McNab S, Njau P, Chandra P, Koyiet P, Levine R, et al. Beyond survival: Prioritizing the unmet mental health needs of pregnant and postpartum women and their caregivers. Chibanda D, editor. PLOS Glob Public Health. 2024 Feb 5;4(2):e0002782. \u003c/li\u003e\n\u003cli\u003eHoward LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. The Lancet. 2014 Nov 15;384(9956):1775\u0026ndash;88. \u003c/li\u003e\n\u003cli\u003eNweke M, Ukwuoma M, Adiuku-Brown AC, Okemuo AJ, Ugwu PI, Nseka E. Burden of postpartum depression in sub-Saharan Africa: An updated systematic review. 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BioMed Res Int. 2020 Jan;2020(1):2408063. \u003c/li\u003e\n\u003cli\u003eTak\u0026aacute;cs L, Seidlerov\u0026aacute; JM, \u0026Scaron;těrbov\u0026aacute; Z, Čepick\u0026yacute; P, Havl\u0026iacute;ček J. The effects of intrapartum synthetic oxytocin on maternal postpartum mood: findings from a prospective observational study. Arch Womens Ment Health. 2019 Aug;22(4):485\u0026ndash;91. \u003c/li\u003e\n\u003cli\u003eTan HS, Tan CW, Sultana R, Chen HY, Chua T, Rahman N, et al. The association between epidural labour analgesia and postpartum depression: a randomised controlled trial. Anaesthesia. 2024 Apr;79(4):357\u0026ndash;67. \u003c/li\u003e\n\u003cli\u003eTong S, Rao C, Min S, Li H, Quan D, Chen D, et al. Obstetric anesthesia clinic childbirth course combined with labor epidural analgesia is associated with a decreased risk of postpartum depression : a prospective cohort study. 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Available from: https://brieflands.com/articles/ijpbs-62558.html\u003c/li\u003e\n\u003cli\u003eZejnullahu VA, Ukella-Lleshi D, Zejnullahu VA, Miftari E, Govori V. Prevalence of postpartum depression at the clinic for obstetrics and gynecology in Kosovo teaching hospital: Demographic, obstetric and psychosocial risk factors. Eur J Obstet Gynecol Reprod Biol. 2021 Jan;256:215\u0026ndash;20. \u003c/li\u003e\n\u003cli\u003eHarrison S, Quigley MA, Fellmeth G, Stein A, Alderdice F. The impact of the Covid-19 pandemic on postnatal depression: analysis of three population-based national maternity surveys in England (2014\u0026ndash;2020). Lancet Reg Health \u0026ndash; Eur [Internet]. 2023 July 1 [cited 2024 Nov 14];30. Available from: https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(23)00073-X/fulltext\u003c/li\u003e\n\u003cli\u003eGoodman JH, Watson GR, Stubbs B. Anxiety disorders in postpartum women: A systematic review and meta-analysis. J Affect Disord. 2016 Oct 1;203:292\u0026ndash;331. \u003c/li\u003e\n\u003cli\u003eSalari N, Sharifi S, Hassanabadi M, Babajani F, Khazaie H, Mohammadi M. Global prevalence of obsessive-compulsive disorder in pregnancy and postpartum: A systematic review and meta-analysis. J Affect Disord Rep. 2024 Dec 1;18:100846. \u003c/li\u003e\n\u003cli\u003eGrekin R, O\u0026rsquo;Hara MW. Prevalence and risk factors of postpartum posttraumatic stress disorder: A meta-analysis. Clin Psychol Rev. 2014 July 1;34(5):389\u0026ndash;401. \u003c/li\u003e\n\u003cli\u003eWorld Health Organization. WHO Recommendations on Maternal and Newborn Care for a Positive Postnatal Experience. 1st ed. Geneva: World Health Organization; 2022. 1 p. \u003c/li\u003e\n\u003cli\u003eWang Z, Liu J, Shuai H, Cai Z, Fu X, Liu Y, et al. Mapping global prevalence of depression among postpartum women. Transl Psychiatry. 2021 Oct 20;11(1):1\u0026ndash;13. \u003c/li\u003e\n\u003cli\u003eHeller HM, Draisma S, Honig A. Construct Validity and Responsiveness of Instruments Measuring Depression and Anxiety in Pregnancy: A Comparison of EPDS, HADS-A and CES-D. Int J Environ Res Public Health. 2022 Jan;19(13):7563. \u003c/li\u003e\n\u003cli\u003eLevis B, Negeri Z, Sun Y, Benedetti A, Thombs BD. Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: systematic review and meta-analysis of individual participant data. BMJ. 2020 Nov 11;371:m4022. \u003c/li\u003e\n\u003cli\u003eSambrook Smith M, Cairns L, Pullen LSW, Opondo C, Fellmeth G, Alderdice F. Validated tools to identify common mental disorders in the perinatal period: A systematic review of systematic reviews. J Affect Disord. 2022 Feb 1;298:634\u0026ndash;43. \u003c/li\u003e\n\u003cli\u003eWaqas A, Koukab A, Meraj H, Dua T, Chowdhary N, Fatima B, et al. 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Prevalence of Perinatal Depression in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2023 May 1;80(5):425\u0026ndash;31. \u003c/li\u003e\n\u003cli\u003eScheid TL, Brown TN, editors. A Handbook for the Study of Mental Health: Social Contexts, Theories, and Systems. Cambridge ; New York: Cambridge University Press; 2010. 736 p. \u003c/li\u003e\n\u003cli\u003eBaumeister H, H\u0026auml;rter M. Prevalence of mental disorders based on general population surveys. Soc Psychiatry Psychiatr Epidemiol. 2007 July 1;42(7):537\u0026ndash;46. \u003c/li\u003e\n\u003cli\u003eBurton HAL, Pickenhan L, Carson C, Salkovskis P, Alderdice F. How women with obsessive compulsive disorder experience maternity care and mental health care during pregnancy and postpartum: A systematic literature review. J Affect Disord. 2022 Oct 1;314:1\u0026ndash;18. \u003c/li\u003e\n\u003cli\u003eZappas MP, Becker K, Walton-Moss B. Postpartum Anxiety. J Nurse Pract. 2021 Jan 1;17(1):60\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eDazzan P. A Step Closer to Understanding Familial Risk for Postpartum Psychosis. Am J Psychiatry. 2025 June;182(6):504\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eNational Library of Medicine. Postpartum Depression Search [Internet]. 2025. Available from: https://pubmed.ncbi.nlm.nih.gov/?term=postpartum+depression\u003c/li\u003e\n\u003cli\u003eNational Library of Medicine. Postpartum Anxiety Search [Internet]. 2025. Available from: https://pubmed.ncbi.nlm.nih.gov/?term=postpartum+anxiety\u003c/li\u003e\n\u003cli\u003eNational Library of Medicine. Postpartum OCD Search [Internet]. 2025. Available from: https://pubmed.ncbi.nlm.nih.gov/?term=postpartum+obsessive+compulsive+disorder\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Postpartum, depression, anxiety, post-traumatic stress disorder, obsessive-compulsive disorder, mental health, prevalence, perinatal, maternal health","lastPublishedDoi":"10.21203/rs.3.rs-7907843/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7907843/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cu\u003eBackground:\u003c/u\u003ePostpartum depression (PPD) and other perinatal mood and anxiety disorders (PMADs) are of critical importance in the postpartum period. However, they remain under-researched beyond the initial six weeks postpartum, especially in low- and middle-income countries (LMICs). The aim of this review was to document the global prevalence of PPD and related PMAD symptoms from six weeks to six months postpartum.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eMethods:\u003c/u\u003e A clinically-oriented search strategy was used to assess peer-reviewed articles published between 2019 and 2024 in PubMed, Embase, and CINHAL. Studies were screened by two independent reviewers for inclusion if they presented primary data around the prevalence of PPD and/or related PMADs from six weeks to six months postpartum (inclusive). Key elements (e.g., country, PMADs measured, measurement interval, prevalence rate) were extracted using Covidence and analyzed in StataBE.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eResults:\u003c/u\u003e Most of the 80 included studies were from high-income and middle-income countries (92.50%) and only measured PPD during the six-to-eight week postpartum interval (53.75%). The median prevalence rates for symptoms of all disorders and PPD were 13.20% and 16.00%, respectively. Rates of PPD symptoms ranged from 0.00% to 76.60% and were most often measured with the Edinburgh Postnatal Depression Scale (EPDS). Cut-off scores used for the EPDS ranged from 9 to 14 with a median of 11, but they were reported inconsistently.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConclusions:\u003c/u\u003e The median prevalence rate (16.00%) of PPD symptoms in this study is consistent with rates found in other studies, indicating that PPD persists beyond the immediate postpartum period. However, this study identified the need for more comparable prevalence data: from LMICs, focusing beyond six-to-eight weeks postpartum, and including disorders other than PPD. Future systematic reviews and qualitative analyses are needed to explore PMAD prevalence rates with more rigor and culturally sensitive concepts.\u003c/p\u003e","manuscriptTitle":"Assessing the Prevalence of Maternal Mental Health Disorders Between Six Weeks and Six Months Postpartum—A Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-13 10:54:45","doi":"10.21203/rs.3.rs-7907843/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7451c893-e543-4ede-a822-4d5c4e820d3a","owner":[],"postedDate":"November 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-10T18:39:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-13 10:54:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7907843","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7907843","identity":"rs-7907843","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}