Why Some Women Get Postpartum Depression and Others Don't

Those differences are the point of my video. When you wonder why you're struggling and someone else seems okay, remember how much you may not know about what each of you is carrying.

Why do some moms get postpartum depression and others don't?

ACOG lists hormone changes, a history of depression, exhaustion and lack of support among possible contributors to postpartum depression (ACOG, 2024). No single factor explains every case.

The National Institute of Mental Health (2023) says perinatal depression "does not have a single cause," and that genes and environment both contribute. In the video above, I talk about why we need to stop comparing moms' postpartum experiences as if they all start from the same place. Think about the difference between:

• the mom whose baby sleeps through the night at eight weeks, and the mom whose baby doesn't for the whole first year
• the mom whose family lives down the street, and the mom who doesn't live near her village
• the mom with six months of paid leave, and the mom with none
• the mom whose partner has paid time off, and the mom whose partner travels for work
• the mom with a history of mood struggles, and the mom with none

Those moms are not having the same postpartum. It helps to think in two parts: what you bring into postpartum (your history, your genes, how your body handles hormone shifts), and what lands on you once you're there (sleep, support, stress, the birth, your baby's health). In general, the more you're carrying from both, the higher the odds, though none of it works like a formula.

How does my mental health history matter?

Your history. NIMH (2023) says risk is higher with a personal or family history of depression or bipolar disorder, or depression with a previous pregnancy. Depression during pregnancy matters too. In a 2020 umbrella review of 21 earlier reviews, Hutchens (University of San Diego) and Kearney (Yale) found prenatal depression was one of the two strongest risk factors. If you're pregnant and something feels off, recognizing prenatal depression early walks through the signs.

You didn't choose any of this.

How much do sleep and support really matter?

Sleep. In a 2001 survey of 738 moms of 6- to 12-month-olds, Hiscock and Wake at the Royal Children's Hospital in Melbourne found that moms who reported their baby's sleep as a problem had about twice the odds of scoring in the probable-depression range, even after accounting for other known risk factors. Moms who reported sleeping well themselves weren't more likely to be depressed, even with a baby who had a sleep problem. It was a snapshot, so it can't show which came first. ACOG (2024) calls fatigue a possible "major contributor" to postpartum depression.

Support. The 2020 umbrella review found lack of social support, high life stress, and dissatisfaction with a partner among the risk factors identified most often. In a 2015 meta-analysis of 120 publications on new and expectant parents, Pilkington and colleagues at Australian Catholic University found that a partner's emotional and practical support was linked with less depression, and conflict with more. A partner who's on a plane every Monday can't offer the same practical help as one who's home, however much they love you.

Leave. In a 2014 study of about 700 employed moms from three Minnesota hospitals, Dagher and colleagues at the University of Maryland found that longer leave, up to about six months, was associated with fewer depressive symptoms. A 2020 review by Van Niel and colleagues in the Harvard Review of Psychiatry linked paid maternity leave with less postpartum depression, and noted that every industrialized country except the United States had a national paid maternity leave policy of 12 weeks or more. So when I say you're operating in a society that frankly doesn't support moms, that's part of what I mean.

Stress and safety. ACOG says stressful life events, like a death in the family, an illness, or a move, "can greatly increase the risk." The umbrella review also found current abuse was one of the two strongest risk factors. If you're not safe at home, the National Domestic Violence Hotline is free, confidential and open 24/7: call 1-800-799-7233 or text START to 88788. If you're in immediate danger, call 911.

Can a hard birth or a sick baby make postpartum depression more likely?

Both are associated with higher risk.

The birth. In a 2016 systematic review, Bell (University of Illinois Chicago) and Andersson (Karolinska Institutet) found that 11 of 15 studies showed a significant link between how women experienced their birth and postnatal depression. Notice the word experienced. A birth can look fine on paper and still have felt frightening or out of control. If your birth keeps replaying in your head, birth trauma recovery is a good place to start.

A baby who's sick or early. A review from Women's College Hospital in Toronto found higher rates of depression among moms of premature babies in the first weeks after birth (Vigod and colleagues, 2010). Ask your care team what support is available for you as well as your baby.

If I have risk factors, is it my fault?

No. NIMH (2023) puts it plainly: "A woman is not to blame or at fault for having perinatal depression: It is not caused by anything she has or has not done."

Risk factors describe odds across large groups. Having one raises your odds, but it doesn't decide what happens to you, and it says nothing about your character. If you're struggling with your mood postpartum, there is nothing wrong with you. You are not broken. You are not weak. Your history and circumstances deserve attention as part of your care.

"What's wrong with me?" tends to lead to hiding. "What am I carrying?" leads somewhere useful. A few things to do with the answer:

• Say your history out loud. Tell your OB, midwife, or doctor about past depression, anxiety or bipolar disorder, any family history of them, and how the birth felt to you.
• Pick one piece of the load that can move. You can't change your genes or your birth. You may be able to change who handles one night wake-up or who brings dinner on Tuesdays.
• Stop grading yourself against her. The friend with the six-hour sleeper may have her mom down the street and a partner home for three months.
• If you're planning another baby, knowing your risk factors lets you plan ahead. Can postpartum depression be prevented? covers that plan.

When is it time to get help?

You don't need to sort out your risk factors first. I'd want you to talk to a professional if:

• you've felt sad, empty, anxious, or flat most of the day, nearly every day, for two weeks or more
• you've lost interest in things you used to care about
• you feel guilty, worthless, or hopeless
• you can't sleep even when your baby is asleep
• you're having trouble bonding with your baby
• you've had any thoughts of death or of not wanting to be here, even passing ones

If you're thinking about suicide or need crisis support, call or text 988. Call 911 if you or your baby is in immediate danger. The same goes for thoughts of not wanting to be alive. If it isn't an emergency, call or text the National Maternal Mental Health Hotline at 1-833-852-6262 (free, 24/7) or the Postpartum Support International HelpLine at 1-800-944-4773, where a trained volunteer calls or texts you back.

You don't have to be sure it's depression, or "bad enough," before you reach out. Postpartum depression symptoms walks through the full picture. And NIMH (2023) is clear: perinatal depression can be treated.

If you'd like to talk it through with someone who works with moms, you can book a free 15-minute consultation. I see moms in person in Austin and online across Texas and in 40+ PSYPACT states.

Sources

• National Institute of Mental Health. Perinatal Depression. NIH Publication No. 23-MH-8116, revised 2023.
• American College of Obstetricians and Gynecologists. Postpartum Depression (FAQ091). Published April 2024, last reviewed December 2025.
• Hutchens BF, Kearney J. Risk factors for postpartum depression: An umbrella review. Journal of Midwifery & Women's Health, 2020.
• Viktorin A, Meltzer-Brody S, Kuja-Halkola R, et al. Heritability of perinatal depression and genetic overlap with nonperinatal depression. American Journal of Psychiatry, 2016.
• Bloch M, Schmidt PJ, Danaceau M, et al. Effects of gonadal steroids in women with a history of postpartum depression. American Journal of Psychiatry, 2000.
• Hiscock H, Wake M. Infant sleep problems and postnatal depression: A community-based study. Pediatrics, 2001.
• Pilkington PD, Milne LC, Cairns KE, et al. Modifiable partner factors associated with perinatal depression and anxiety: A systematic review and meta-analysis. Journal of Affective Disorders, 2015.
• Dagher RK, McGovern PM, Dowd BE. Maternity leave duration and postpartum mental and physical health: Implications for leave policies. Journal of Health Politics, Policy and Law, 2014.
• Van Niel MS, Bhatia R, Riano NS, et al. The impact of paid maternity leave on the mental and physical health of mothers and children: A review of the literature and policy implications. Harvard Review of Psychiatry, 2020.
• Bell AF, Andersson E. The birth experience and women's postnatal depression: A systematic review. Midwifery, 2016.
• Vigod SN, Villegas L, Dennis CL, Ross LE. Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: A systematic review. BJOG, 2010.
• 988 Suicide & Crisis Lifeline. What to Expect.
• Postpartum Support International. Perinatal Mental Health: Signs, Symptoms and Treatment and Get Help.