Environmental risk factors, protective factors, and biomarkers for postpartum depressive symptoms: an umbrella review

Jae Han Kim, Jong Yeob Kim, Seul Lee, San Lee, Brendon Stubbs, Ai Koyanagi, Elena Dragioti, Louis Jacob, Andre F. Carvalho, Joaquim Radua, Trevor Thompson, Lee Smith, Hans Oh, Lin Yang, Michele Fornaro, Andrew Stickley, Gonzalo Salazar de Pablo, Kalthoum Tizaoui, Dong Keon Yon, Seung Won LeeJimin Hwang, Jae Il Shin, Paolo Fusar-Poli

Research output: Contribution to journalReview articlepeer-review

5 Citations (Scopus)


We performed an umbrella review on environmental risk/protective factors and biomarkers for postpartum depressive symptoms to establish a hierarchy of evidence. We systematically searched PubMed, Embase, and the Cochrane Database of Systematic Reviews from inception until 12 January 2021. We included systematic reviews providing meta-analyses related to our research objectives. Methodological quality was assessed by AMSTAR 2, and the certainty of evidence was evaluated by GRADE. This review was registered in PROSPERO (CRD42021230784). We identified 30 articles, which included 45 environmental risk/protective factors (154,594 cases, 7,302,273 population) and 9 biomarkers (2018 cases, 16,757 population). The credibility of evidence was convincing (class I) for antenatal anxiety (OR 2.49, 1.91–3.25) and psychological violence (OR 1.93, 1.54–2.42); and highly suggestive (class II) for intimate partner violence experience (OR 2.86, 2.12–3.87), intimate partner violence during pregnancy (RR 2.81, 2.11–3.74), smoking during pregnancy (OR 2.39, 1.78–3.2), history of premenstrual syndrome (OR 2.2, 1.81–2.68), any type of violence experience (OR 2.04, 1.72–2.41), primiparity compared to multiparity (RR 1.76, 1.59–1.96), and unintended pregnancy (OR 1.53, 1.35–1.75).

Original languageEnglish
Article number104761
JournalNeuroscience and Biobehavioral Reviews
Publication statusPublished - 2022 Sept

Bibliographical note

Funding Information:
All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: GSP is supported by Alicia Koplowitz Foundation and Janssen Cilaq. BS is supported by a National Institute for Health Research (NIHR) Advanced Fellowship (301206, 2021–20216). BS is a lead/co-investigator the following active grants 1) NIHR program grant: Supporting Physical and Activity through Co-production in people with Severe Mental Illness (SPACES,2021–2027); 2) TB multimorbidity with the Medical Research Council (GCRF call (2020–2022); 3) Determinants of MLTCs among young adults with mental disorders: a data-linkage study, Guy's & St Thomas' Charity (2020–2022); 4) Mechanisms underlying the role of gut-microbiota in exercise-induced changes in cognitive function in middle-age, Reta Lila Weston Trust For Medical Research (2021–2024); 5) Improving Outcomes in Mental and Physical Multi-morbidity and Developing Research Capacity (IMPACT) in South Asia, NIHR Global Research program grant (2017–2022). BS also works at King’s College London; disseminating and publishing evidence is integral to his employment (although his salary is wholly covered by the above fellowship). BS also works clinically with people that use mental health services in the National Health Service (NHS). BS has published a book on exercise and mental illness and is on the Editorial board of Ageing Research Reviews, Mental Health and Physical Activity, The Journal of Evidence Based Medicine and The Brazilian Journal of Psychiatry. BS has received honorarium for advisory work from ASICS Europe BV & Parachute BH for work unrelated to this project. The views expressed are those of the author(s) and not necessarily those of mentioned above, the NHS, the NIHR, the Department of Health and Social Care, the MRC or GSTT.

Publisher Copyright:
© 2022 Elsevier Ltd

All Science Journal Classification (ASJC) codes

  • Neuropsychology and Physiological Psychology
  • Cognitive Neuroscience
  • Behavioral Neuroscience


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